Thread by @PanktiMehta24

😣Patient: "All my joints are painful & swollen!"😣

👩‍⚕️But when you examine the patient, you don't find any joint swelling

How to approach this scenario? 🤷

#MedTwitter #RheumTwitter #MedEd 🧵🧵🧵

(1/10)

Now there are two possibilities

1️⃣ There was a joint swelling which is no longer there

OR

2️⃣ There was no joint swelling to begin with

(2/10)

Let's start with the first one– there was indeed joint swelling which is no longer there

That means we are dealing with

☝️ An episodic inflammatory disease
✌️ Drug modified disease

(3/10)

☝️Episodic inflammatory diseases

💭 Of

🔹#Gout
🔹CPPD
🔹Palindromic #rheumatoid arthritis
🔹Autoinflammatory syndromes
🔹Spondyloarthritis (especially reactive)

(4/10)

✌️ Drug-modified disease

Any inflammatory arthritis can be modified by the use of

🔹Steorids 👿
🔹DMARDs💊
🔹Complementary & alternative drugs 👿👿👿! (Very important)

So take that history well and check all records !

(5/10)

Now, let's move to scenario no.
2️⃣ There was no joint swelling to begin with

This raises 2 questions

☝️are we dealing with #arthritis?
✌️or is it something else?

(6/10)

☝️ So, what kinds of arthritis may not have joint swelling?

Simple- The ones that are non inflammatory!

💭 of

Osteoarthritis

(7/10)

✌️is it even arthritis or something else?

Confirm if the pain is restricted to the joints or not?

Regional/diffuse pain could be related to

🔹Fibromyalgia
🔹Hypermobility disorders
🔹Myalgia
🔹Bone pains
🔹Osteomalacia
🔹Neurologic pain
🔹Soft tissue rheumatism

(8/10)

Also, some diseases may only have polyarthralgia

🔹Lupus
🔹Sjogren
🔹Post Viral syndromes
🔹Hypothyroidism

(9/10)

In summary,

✅Joint pain without ❎swelling

💭 of
🔹Episodic #arthritis
🔹Drug modified arthritis
🔹Non inflammatory arthritis
🔹Regional/widespread #pain syndromes
🔹Systemic diseases with polyarthralgia!

(10/10)