Thread by @KragstrupTW

Who needs a rheumatology consult?

How does the rheumatologist think about pain?

This is part of the new @EMEUNET initiative #EMEUNETonCourse to promote knowledge-sharing about rheumatology.

emeunet.eular.org/eular_online_c…

This #tweetorial will describe the four phases of the thinking process to clarify whether the pain is "joint-related inflammatory pain".

It is my personal view based on #Chapter1 of the the @eular_org online course #EULARonlinecourseOnRheumaticDiseases.

Please comment.

Phase 1) Is this musculoskeletal pain?

Musculoskeletal pain is characterized by worsening pain with movement. This discriminates musculoskeletal pain from the other types of pain:

👎 exclude referred pain / visceral pain

👎 exclude neurogenic pain

Phase 2) Is this insidious onset pain? 👍

👎 exclude trauma

👎 exclude stress related / exercise induced pain

Phase 3) Is this inflammatory pain?

What characterizes pain caused by inflammation?

Answer:

Inflammatory pain is characterized by 1) pain that is worst at rest and eases with use, 2) morning stiffness and 3) a better response to NSAIDs 👍

👎 exclude degenerative causes of pain

👎 exclude generalized / widespread pain

Phase 4) Is the pain coming from the joint or the soft tissue?

1) Pain with passive movement and 2) swelling located to correct anatomical location.

DDx tenosynovitis (resisted movements), bursitis (anatomical location), and enthesitis (no swelling) are also #rheumstuff.

Now what?

Time to refer to a rheumatologist 😀

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