INTRODUCTION

Musculoskeletal complaints are common in the acute care setting. A systematic approach is critical to determine whether the patient is afflicted with a potentially joint-damaging infection or can be safely referred back to their primary provider or a specialist for further work-up and management. The first step in evaluating a patient who complains of joint pain is to establish that the patient does in fact have true arthritis, consisting of pain (arthralgia) and swelling at the affected joint. Periarticular pain also can arise from bursitis, tendonitis, ligamentous damage, and skin pathology such as a cellulitis. Once a diagnosis of true arthritis has been established, the clinician can organize an approach by addressing a few key questions.

• Is the arthritis acute or nonacute?

• What is the pattern of the joint involvement?

1. ◦ How many joints are affected?

2. ◦ What is the distribution of the joint involvement?

• Are there hints of systemic disease?

Acute arthritis is defined by the onset of symptoms over hours to several days. Development and persistence of symptoms and signs over many days to weeks indicates a subacute process. The full musculoskeletal exam will reveal a monoarticular (involving one joint), oligoarticular (involving two to four joints), or polyarticular (involving five or more joints) arthritis. When addressing an oligo- or polyarticular process, determine whether the arthritis is unilateral or symmetric (e.g., affecting both wrists or the small joints of the fingers of both hands).