What to bring when a doctor checks joint pain

What to record with chronic joint pain

Note whether you can walk your usual distance, rise from a chair, sleep well, and use the joint. A long-lasting ache can change as weaker muscles and poor sleep add more strain.

This doesn’t mean the soreness is imagined or that the joint no longer matters. It means your doctor needs to hear what has changed in daily life since the ache began.

What to check with body aches and joint pain

Widespread aches can follow an illness, a medicine change, heavy activity, or poor sleep. Swollen joints, fever, rash, or long morning stiffness make a doctor’s exam more important.

Keep taking prescribed medicine while you call the doctor who ordered it about the new soreness. Bring the medicine name and the date your aches began to that call.

What to expect when the joint is examined

The doctor will check swelling, warmth, motion, strength, and nearby joints or nerves. You’ll also be asked whether rest, use, or time of day changes the soreness.

The doctor may draw fluid from a hot, swollen joint with a needle and test it. The test can separate infection from sharp crystals that cause gout-like swelling, even without fever.

What to ask before having a test

Ask what the test is meant to find and how its result would change your care. If that isn’t clear, the doctor may repeat joint movements and check nearby nerves before ordering it.

Testing becomes more urgent after severe injury, sudden weakness, or a hot, swollen joint. Those changes shouldn’t be handled as an ordinary flare with a few quiet days at home.

Sources

1. A EULAR task force of 18 rheumatologists, 3 health professionals, 2 patients and a methodologist defined which joint symptoms, in the absence of any visible swelling, should make a clinician suspect that inflammatory arthritis is coming. Seven parameters survived: symptom duration under one year, symptoms in the knuckle (metacarpophalangeal) joints, morning stiffness lasting 60 minutes or more, symptoms worst in the early morning, a first-degree relative with rheumatoid arthritis, difficulty making a fist, and a positive squeeze test of the knuckles. The combination identified at-risk patients with an area under the ROC curve of 0.92 (95% CI 0.87-0.96).

   van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJJ, et al. — EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis.. Annals of the Rheumatic Diseases, 2017. DOI: 10.1136/annrheumdis-2016-209846.

2. In a structured review of 14 studies covering 6,242 patients with an acutely painful swollen joint (653 with confirmed septic arthritis), no single symptom rules the diagnosis in or out: joint pain was present in 85%, a history of joint swelling in 78%, and fever in only 57%. The most powerful bedside data came from aspirating the joint - the summary likelihood ratio rose with the synovial fluid white cell count, from 0.32 below 25,000/microL to 2.9 at 25,000 or more, 7.7 above 50,000 and 28.0 above 100,000.

   Margaretten ME, Kohlwes J, Moore D, Bent S — Does this adult patient have septic arthritis?. JAMA, 2007. DOI: 10.1001/jama.297.13.1478.

3. Fifty-one men aged 40-70 with no symptoms in either shoulder had one shoulder scanned by ultrasound to a defined protocol. Abnormalities were found in 96% of them: subacromial-subdeltoid bursal thickening in 78%, acromioclavicular joint osteoarthritis in 65%, supraspinatus tendinosis in 39%, subscapularis tendinosis in 25%, a partial-thickness bursal-side supraspinatus tear in 22% and a posterior labral abnormality in 14%.

   Girish G, Lobo LG, Jacobson JA, Morag Y, Miller B, Jamadar DA — Ultrasound of the shoulder: asymptomatic findings in men.. American Journal of Roentgenology, 2011. DOI: 10.2214/AJR.11.6971.

4. In the Framingham Osteoarthritis Study, 710 people over 50 with NO radiographic evidence of knee osteoarthritis underwent knee MRI: 89% had 'any abnormality'. Osteophytes appeared in 74%, cartilage damage in 69% and bone marrow lesions in 52%. Prevalence of at least one abnormality was 90-97% in painful knees and 86-88% in painLESS knees.

   Guermazi A, et al. — Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study).. BMJ, 2012. DOI: 10.1136/bmj.e5339.

5. The 2010 ACR/EULAR classification criteria define 'definite rheumatoid arthritis' by confirmed synovitis in at least one joint, absence of a better alternative diagnosis, and a total score of 6 or more out of 10 across four domains: number and site of involved joints (0-5), serology (0-3), acute-phase response (0-1) and symptom duration (0-1). This is the formal boundary between inflammatory arthritis and degenerative joint disease.

   Aletaha D, et al. — 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.. Arthritis Rheum, 2010. DOI: 10.1002/art.27584.