Evaluation of the adult with polyarticular pain
- Robert H Shmerling, MD
Robert H Shmerling, MD
- Section Editor — Diagnostic Issues in Rheumatology
- Associate Professor of Medicine
- Harvard Medical School
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
Polyarticular pain in an adult is encountered frequently in clinical practice. The causes include various self-limited illnesses and others that are potentially disabling and life-threatening. The history and physical examination generally provide the most useful diagnostic information; supporting or confirmatory data are obtained from laboratory and imaging studies or, more rarely, from tissue biopsy. A complete history and physical examination are appropriate for all patients presenting with polyarticular joint pain, since this symptom may be the initial manifestation of a systemic illness.
The list of causes of polyarticular pain is lengthy [1,2] and includes:
●Polyarthritis (table 1)
●Viral arthritis (table 2)
●Postinfectious or reactive arthritis
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- Musculoskeletal emergencies
- Joint symptoms
- Associated symptoms
- Other clues from the history
- PHYSICAL SIGNS
- Joint examination
- General examination
- LABORATORY STUDIES
- Erythrocyte sedimentation rate
- Antibody tests
- - Antinuclear antibody
- - Rheumatoid factor
- - Antibodies to citrullinated peptides
- Serum uric acid concentration
- Synovial fluid analysis
- IMAGING STUDIES
- TISSUE BIOPSY
- DISEASE COURSE
- INFORMATION FOR PATIENTS