What is the diagnosis?
What is the differential diagnosis for a patient presenting with musculoskeltal pain ?
Musculoskeletal pain can also be caused by:
• Connective tissue diseases (scleroderma and lupus) that have other specific systemic signs.
• Fibromyalgia—Pain at trigger points instead of joints.
• Polyarticular gout—Erythematous joints and crystals in joint aspirate
• Polymyalgia rheumatica—Proximal joint pain without deformity, elevated ESR.
• Seronegative spondyloarthropathies—Asymmetric joint involvement, spine often involved.
• Reactive arthritis—History of infection, sexually transmitted disease, or bowel complaints. The patient may have conjunctivitis, iritis, urethritis in addition to joint pain and arthritis.
• Rheumatoid arthritis—Symmetric soft-tissue swelling in distal joints, stiffness after inactivity, positive rheumatoid factor. Ulnar deviation of the fingers at the MCP joints is a distinct finding in
• Bursitis—Pain at one site, often increased with direct pressure.
How would you manage a case of Osteoarthritis?
Non pharmacologic Options for Osteoarthritis include:
- Weight loss (if overweight)
- Aerobic exercise
- Range-of-motion exercises
- Assistive devices for walking
- Safe shoes
- Physical and Occupational therapy
- Joint protection such as braces
- Assistive devices for activities of daily living
- Social support
1. Oral Medicines :
• COX-2-specific inhibitor
• NSAID plus a proton pump inhibitor
• Opioids (e.g. hydrocodone)
2, Topical Medicines:
• Topical NSAID (e.g diclofenac gel)
• Glucocorticoids (e.g. triamcinolone)
• Hyaluronic acid