creation date: 2026-02-02 17:49
tags: Workups
Polyarthralgia
Background
Polyarthralgia, also referred to as polyarticular joint pain, is a common complaint with etiologies ranging from self-limiting illnesses to potentially life-threatening.
Pathophysiology
Pain may occur due to conditions that affect the joints (arthropathy). This may be without inflammation (arthralgia) or with inflammation (arthritis).
Inflammation may occur in the synovial membrane (synovitis) or the tendon (tenosynovitis, enthesitis).
Differential Diagnosis
Causes include conditions with inflammatory features
Rheumatic diseases:
- Inflammatory arthritis (eg. rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica)
- Connective tissue diseases (eg. systemic lupus erythematosus)
- Vasculitis
Metabolic disorders:
- Gout
- Calcium pyrophosphate crystal deposition
Infectious:
- Septic arthritis
- Acute arthritis from viral infection
Causes without inflammatory features
Mechanical:
- Osteoarthritis
- Joint hypermobility
Centralized pain:
- Fibromyalgia
- Pain syndromes
Others:
- Neuropathies
- Infectious syndromes
- Medications (eg. aromatase inhibitors and statins)
- Endocrinopathies
- Metabolic bone diseases
- Paraneoplastic syndromes
Initial Evaluation
History
Concerning features on history include neurologic symptoms or anything that indicates infection or critical illness.
History should elicit characteristic of the pain:
- Location and distribution
- Quality
- Time of onset and precipitating factors
- Duration of symptoms
- Exacerbating factors
- Impact on function
Inflammatory features include:
- Prolonged morning stiffness that improves with activity
- Painful joints not typical of OA (eg. wrists, MCP joints, 2nd-5th MTP joints)
- Painful tendon sites
- Onset in multiple joints over relatively short time span (eg. weeks to months)
- Improvement with NSAIDs
Additional symptoms to elicit include:
- Weakness
- Rashes
- Fever
- Multisystem involvement
- Somatic symptoms (eg. fatigue, mood disturbances)
- Medications
Physical Exam
MSK exam should be performed on the peripheral joints and spine.
On inspect, note:
- Signs of inflammation
- Characteristic patterns of deformities
- Presence of tophi (gout)
Palpation should attempt to detect inflammatory signs:
- Warmth
- Soft tissue swelling
- Effusion
- Tenderness at joint lines and tendon insertion
- Erythema and/or hyperpigmentation
Non-inflammatory pain typically have normal findings.
Active and passive ROM in addition to evaluation of aggravating movements should be performed.
Additional physical exam may be warranted based on extrarticular symptoms reported in history.
Investigations
In patients with inflammatory features
- CBC
- Acute phase reactants (ESR/CRP)
- Renal function
If the patient has had symptoms ≤6 weeks:
- Gout workup
- Viral arthritis serologies guided by risk factors (hep B and C, parovirus)
If the patient has had symptoms >6 weeks:
- Serologic testing (RF, ACPA, ANA)
- Urine studies if kidney injury is a sequelae of suspected condition
Imaging is not routine but may be obtained depending on suspected diagnosis:
- Rheumatoid arthritis - wrist, hand, foot XR
- Spondyloarthropathy - pelvis, SI XR
In patients without inflammatory features
Further testing may or may not be required depending on the conditions (eg. OA and PMR have their separate workup).