Polyarthralgia (pain in more than four joints)

Rationale

Polyarthralgia is chronic pain in or around more than four joints and often presents as a symptom of common disabling diseases. It is responsible for substantial morbidity and functional impairment. Many 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. Through history and physical examination, the candidate will determine the acuity and severity of the problem. In particular, the candidate will determine if the condition is inflammatory or noninflammatory 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 those based on
   1. a history and physical examination to determine whether the problem is articular or nonarticular, and, if articular, whether it is inflammatory or mechanical,
   2. a history and physical examination to identify other features to help make a more definitive diagnosis (e.g., rheumatoid nodules, tophi, psoriasis, onycholysis), and
   3. assessment of the impact of the condition on the patient’s function;
2. list critical investigations and interpret the results of the investigations, including
   1. appropriate laboratory tests and other tests (e.g., radiology, erythrocyte sedimentation rate [ESR], antinuclear antibodies [ANA]);
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, and
   4. counselling regarding appropriate return to activities.