#BinanceHODLerRESOLV onclusion 165
Musculoskeletal Complaint
Initial rheumatic history and physical
exam to determine
1. Is it articular?
2. Is it acute or chronic
3. Is inflammation present?
4. How many/which joints are involved?
No
Acute
Nonarticular condition
Consider
● Trauma/fracture
● Fibromyalgia
● Polymyalgia rheumatica
● Bursitis
● Tendinitis
Consider
● Acute arthritis
● Infectious arthritis
● Gout
● Pseudogout
● Reactive arthritis
● Initial presentation
of chronic arthritis
Is inflammation present?
1. Is there prolonged morning stiffness?
2. Is there soft tissue swelling?
3. Are there systemic symptoms?
4. Is the ESR or CRP elevated?
Chronic
noninflammatory
arthritis
Chronic
inflammatory
arthritis
How many
joints involved?
Chronic inflammatory
polyarthritis
Is involvement
symmetric?
Are PIP, MCP, or
MTP joints
involved?
Consider
● Psoriatic arthritis
● Reactive arthritis
Unlikely to be osteoarthritis
Consider
● Osteonecrosis
● Charcot arthritis
Chronic inflammatory
mono/oligoarthritis
Consider
● Indolent infection
● Psoriatic arthritis
● Reactive arthritis
● Pauciarticular JA
Unlikely to be rheumatoid arthritis
Consider
● SLE
● Scleroderma
● Polymyositis
Osteoarthritis
Are DIP, CMC1, hip or
knee joints involved?
Rheumatoid
arthritis
1-3 >3
No
No
No
Yes
Yes
Yes
No
No
Is it articular?
Chronic
Is complaint > 6 wk?
