The Clinical Problem Solvers Episode 440: Subspecialty Episode – Pelvic & Joint Pain
Jan 22, 2026
In this discussion, Greg Kirshen, a second-year maternal-fetal medicine fellow with a knack for diagnostic reasoning, presents a case of a 30-year-old man suffering from complex pelvic and joint pain following a COVID infection. The conversation dives deep into distinguishing neurological versus rheumatological causes for mixed symptoms. They unravel clues from physical exams and lab results, explore the implications of seronegative spondyloarthropathy, and discuss the significance of imaging for accurate diagnosis. A riveting look at post-COVID complications!
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Perianal Numbness Narrows Localization
- Perianal numbness with diffuse pain often signals nerve involvement rather than purely rheumatologic disease.
- Localizing symptoms guides whether to prioritize spine/neurology versus pelvic or rheumatologic workups.
Periarthritis Suggests Seronegative Disease
- Multifocal tendonitis and enthesitis with minimal joint synovitis points toward seronegative spondyloarthropathy.
- Absence of erosions and normal inflammatory markers doesn't exclude seronegative disease.
Gout Caused Persistent Foot Hyperemia
- Yusuf recalled a gout patient with severe flare causing permanent hyperemia and foot discoloration.
- He used this to illustrate inflammatory hyperemia as a cause of unilateral erythema.