Polyarthralgia (pain in more than four joints)

Rationale

Chronic pain in or around multiple joints is often the presenting symptom of common, disabling diseases, responsible for a great burden of suffering, loss of function and morbidity. Many of these patients may benefit from early diagnosis and treatment.

Causal Conditions

(list not exhaustive)

1. Inflammatory joint pain (e.g., rheumatoid arthritis, juvenile polyarthritis)
2. Mechanical joint pain (e.g., osteoarthritis)
3. Non-articular disease (e.g., fibromyalgia, polymyalgia rheumatica)

Key Objectives

Given a patient with widespread musculoskeletal pain, the candidate will be able to differentiate true joint disease from other causes, and through history and physical exam determine the acuity and severity of the problem. In particular, the candidate will determine if the disease is inflammatory or not, and initiate appropriate treatment or referral.

Enabling Objectives

Given a patient with joint pain, the candidate will

1. list and interpret critical clinical findings, including
   1. determining, based on the history and physical examination, whether it is an articular problem and, if so, if it is inflammatory or mechanical;
   2. determining, based on the history and physical examination, whether there are other features that help make a more definitive diagnosis (e.g., rheumatoid nodules);
   3. impact on function;
2. list and interpret critical investigations, including
   1. appropriate laboratory investigations and other tests (e.g., radiology, erythrocyte sedimentation rate, anti-CCP [anti-cyclic citrullinated peptide]);
3. construct an effective management plan, including
   1. immediate treatment of urgent conditions (e.g., polymyalgia rheumatica);
   2. immediate symptomatic and supportive treatment (e.g., anti-inflammatories);
   3. appropriate referral for more specialized care (e.g., rheumatology, physiotherapy), if indicated;
   4. counselling regarding appropriate return to activities.