The Clinical Problem Solvers Episode 334: Rafael Medina Subspecialty Series – Polyarticular Joint Pain
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May 8, 2024 Rheumatologist Rafael Medina discusses polyarticular joint pain with Dr. Lianne Gensler, exploring inflammatory vs. non-inflammatory causes, morning stiffness, spondyloarthritis differentiation, radiographic vs. non-radiographic axial spondyloarthritis, and management of neurological complications in arthritis treatment.
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Joint Size Guides Diagnosis
- Polyarticular joint pain with both small and large joint involvement narrows differential diagnosis in inflammatory arthritis.
- Rheumatoid arthritis, psoriatic arthritis, and lupus are key considerations based on joint size and location.
Morning Stiffness Indicates Inflammation
- Morning stiffness that improves with movement suggests inflammatory arthritis rather than mechanical.
- Response to NSAIDs, especially naproxen, is characteristic of spondyloarthritis.
Check for Extra-Musculoskeletal Signs
- Screen for extra-musculoskeletal symptoms like psoriasis, uveitis, and IBD in suspected spondyloarthritis.
- Obtain family history and inquire about ancestry to assess genetic risks such as HLA B27.
