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Joint pain treatment algorithm.
Tables
Trauma Sprain Strain Fracture Dislocation Tear of ligament, tendon, or meniscus Tendinitis Infection Gonococcal Nongonococcal-viral, mycobacterial, or fungal Lyme disease Secondary to bacterial endocarditis Secondary to enteric and urogenital infections Crystal-induced arthropathy Gout Pseudogout Degenerative joint disease Osteoarthritis Malignancy Tumor Metastases Leukemia Rheumatic Rheumatoid arthritis Reiter syndrome Psoriatic arthritis Lupus erythematosus Ankylosing spondylitis Other Complex regional pain syndrome Sjögren syndrome Polymyositis Scleroderma Sarcoidosis Fibromyalgia Erythema nodosum Sickle cell disease Aseptic necrosis Charcot Drug reaction Hypothyroidism Irritable bowel syndrome Osteochondritis dissecans Information from refs. 7, 8, and 13.
Osteoarthritis 20,700,000 Rheumatoid arthritis 2,100,000 Gout 2,100,000 Polymyalgia rheumatica & giant cell arteritis 560,000 Spondyloarthropathy 383,000 Systemic lupus erythematosus 239,000 Juvenile rheumatoid arthritis 40,000 Adapted from ref. 6.
Condition Appearance WBCs/mma %PMNs Glucose Serum Level (%) Crystals under Polarized Light Normal Clear <200 <25 95–100 None Noninflammatory (eg, degenerative joint disease) Clear <400 <25 95–100 None Acute gout Turbid 2,000–5,000 >75 80–100 Negative birefringence; needle-like crystals Pseudogout Turbid 5,000–50,000 >75 80–1000 Positive birefringence; rhomboid crystals Septic arthritis Purulent/turbid >50,000 >75 <50 None Inflammatory (eg, rheumatoid arthritis) Turbid 5,000–50,000 50–75 ∼75 None Adapted from ref. 15.
a WBC, white blood cell; PMN, polymorphonuclear cell.
Advanced age History of ulcers Corticosteroid use Use of oral anticoagulants Serious systemic disorder Diagnosis Therapy Septic joint Antibiotics Gout Colchicine, allopurinol Muscle spasm Muscle relaxants Associated neuropathic pain Topical capsaicin, anti-depressants Associated muscle pain Topical or oral NSAID, topical lidocaine Rheumatoid arthritis DMARDs,a steroids Osteoarthritis Glucosamine a DMARD, disease-modifying antirheumatic drug.
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