Joint Pain :: PLAB 2 Symptomatic Differential Stations

• Septic arthritis

  • Other presenting symptoms: 

    • Fever

    • Hot, Red, Swollen joints 

  • Past history and PMAFTOSA: 

    • Immunocompromised?

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Joint examination and Xray

  • Referral:

    • Medicine admission

  • Treatment: 

    • Painkillers

    • Antibiotics

    • Synovial fluid tap

  • Warning signs:

    • Symptoms getting worse, drowsiness

• Acute gout

  • Other presenting symptoms: 

    • Hot, Red, Swollen big toe 

  • Past history and PMAFTOSA: 

    • Alcohol history

    • Medication history

    • Family history

  • Social: 

    • Work effects

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Joint examination and Xray

    • Uric acid levels

  • Referral:

    • None

    • Follow up in 4-6 weeks

  • Treatment: 

    • Painkillers (NSAIDs, Colchicine)

    • General measures:

      • RICE

      • Avoid alcohol, red meat 

      • Lose weight 

  • Warning signs:

    • Symptoms getting worse, high fever

• Rheumatoid arthritis

  • Other presenting symptoms: 

    • Small joints

    • Worse in the morning and after rest

    • Better after moving

    • Stiffness 

    • Fatigue, low grade fever, weight loss, LOA

  • Past history and PMAFTOSA: 

    • Family history

  • Social: 

    • Life effects

    • Work effects

    • Mood

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Rheumatoid factor

    • Joint examination and Xray

  • Referral:

    • Rheumatology urgent referral

  • Treatment: 

    • Painkillers

    • Physiotherapist, Occupational therapist

    • Synovial fluid tap

  • Warning signs:

    • Symptoms getting worse, fever, redness of joints 

• Tennis elbow (354)

  • Other presenting symptoms: 

    • Only one elbow joint

    • Outer side of the elbow

    • Tennis history

  • Past history and PMAFTOSA: 

    • Trauma history

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Joint examination and Xray

  • Referral:

    • None

  • Treatment: 

    • Painkillers

    • Do PRICE, avoid HARM

  • Warning signs:

    • Symptoms getting worse, joint redness, high fever

• De Quervain's tenosynovitis

  • Other presenting symptoms: 

    • Only one wrist joint (at the base of thumb)

    • Constant pain, worse with movement, no other symptoms

  • Past history and PMAFTOSA: 

    • Trauma history

  • Social: 

    • Work effects

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Joint examination and Xray

  • Referral:

    • None

  • Treatment: 

    • Painkillers

    • Do PRICE, avoid HARM

    • Splinting 

  • Warning signs:

    • Symptoms getting worse, joint redness, high fever

• Chronic Tophaceous Gout

  • Other presenting symptoms: 

    • Swelling of the fingers/toes

    • Incidental finding sometimes, usually asymptomatic

  • Past history and PMAFTOSA: 

    • History of an untreated gout attack

    • Alcohol history 

    • Medication history

    • Family history

  • Social: 

    • Life effects

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP), uric acid

    • Joint examination and Xray

  • Referral:

    • Routine Rheumatology

  • Treatment: 

    • Uric acid lowering drugs

      • Allopurinol

      • Febuxostat

    • General measures:

      • Avoid alcohol

      • Avoid red meat

  • Warning signs:

    • Symptoms getting worse, joint redness, high fever

• Reactive arthritis 

  • Other presenting symptoms: 

    • Multiple joints

    • History of recent infection (URTI/AGE)

    • Stiffness on rest

    • Improves of movement

  • Past history and PMAFTOSA: 

    • Rule out Trauma history

  • Social: 

    • Work effect

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Joint examination and Xray

  • Referral:

    • None

  • Treatment: 

    • Painkillers

    • self-limiting

  • Warning signs:

    • Symptoms getting worse, joint redness, high fever

• Osteoarthritis of the hip / Trochanteric bursitis 

  • Other presenting symptoms: 

    • Single/Multiple Large joints

    • Restriction of movement 

    • Clicking sound when moving the joints

  • Past history and PMAFTOSA: 

    • Rule out Trauma history

  • Social: 

    • Life effects

    • Work effects

    • Mood

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP)

    • Joint examination and Xray

  • Referral:

    • None

  • Treatment: 

    • Painkillers, Steroids, Surgery

    • General advice:

      • Weight loss

      • Cold/Hot compression

      • Local muscle strengthening exercises

    • Physiotherapy/occupational therapy

  • Warning signs:

    • Symptoms getting worse, joint redness, high fever

• Polymyalgia rheumatica

  • Other presenting symptoms: 

    • Proximal muscle and joint pains and weakness

    • Unable to lift arms above the head, unable to stand up from sitting position

    • Worsen with rest 

    • Improves with activity

  • Past history and PMAFTOSA: 

    • Rule out GCA symptoms

  • Social: 

    • Life effects 

    • Work effects

    • Mood

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods, inflammatory markers(ESR, CRP), RF

    • Joint examination and Xray

    • Eye examination

  • Referral:

    • Rheumatology urgent

  • Treatment: 

    • Painkillers initially 

    • Steroids once confirmed

    • Aspirin and bisphosponates

  • Warning signs:

    • Steroid card

    • Stop smoking

    • Don’t stop taking steroids abruptly

    • Regular follow ups

    • GCA

      • Temporal headache

      • Blurry vision