Joint Pain (Arthralgia): Or something else? Differential Diagnosis

Blood, blood-forming organs-immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions
  • Menopause or postmenopause (menopause in women).
  • Wilson’s disease (copper storage disease) – autosomal recessive inherited disease in which copper metabolism in the liver is disturbed by one or more gene mutations.

Infectious and parasitic diseases (A00-B99).

  • Bacterial infections with Yersinia
  • Lyme disease (synonyms: Borrelia burgdorferi; Borrelia; Borreliosis; Lyme disease; relapsing fever-Borrelia; relapsing fever; spirillium fever) – it is an infectious disease caused by the bacterium Borrelia burgdorferi.
  • Coxsackie A/B
  • Cytomegaly – disease caused by the human cytomegalovirus (HCMV), also called human herpes virus 5 (HHV 5).
  • Gonorrhea (synonym: gonorrhea), generalized – one of the most common sexually transmitted diseases.
  • Chikungunya hemorrhagic fever – infectious disease caused by the Chikungunya virus (CHIKV; from the family Togaviridae).
  • HIV
  • Hepatitis B (liver inflammation, type B)
  • Hepatitis C (liver inflammation, type C)
  • Influenza (flu) including avian influenza (bird flu).
  • Cat scratch disease (bacillary angiomatosis) – transmission by injury from a cat; clinical signs: occurrence of regional lymphadenitis, cephalgia (headache), anorexia (loss of appetite), nausea (nausea), pain in the limbs, arthralgia (joint pain), exanthema (rash), thrombocytopenia (lack of platelets), parotid swelling (swelling of the parotid gland).
  • Legionellosis – infectious disease caused predominantly by the bacterium Legionella pneumophila.
  • Lymphogranuloma venereum – sexually transmitted disease transmitted by serotypes L1-L3 of the bacterial species Chlamydia trachomatis.
  • Bang’s disease (synonym: brucellosis) – caused by Brucella abortus; transmitted by: unpasteurized milk and cheese made from it; Brucella is able to survive in it for several weeks, from this survivability is the main route of infection; up to 90% of infections are subclinical; clinical symptoms: dry cough, night sweats, arthralgia (joint pain), weight loss, myalgia (muscle pain), fever (undulating);
  • Mycoplasma
  • Rheumatic fever (synonym: streptococcal rheumatism) – reactive disease that usually occurs after infection with group A streptococci (Lancefield classification).
  • Syphilis (lues; venereal disease).
  • Viral infections with parvovirus B19 – triggers erythema infectiosum (synonym: ringworm) in children: in adults it can lead to a clinical picture of acute symmetric polyarthropathy (of the joints)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum). The involvement is usually continuous and originates from the rectum. The small intestine is not affected by the disease.
  • Crohn’s disease – chronic inflammatory bowel disease. It usually progresses in episodes and can affect the entire digestive tract. Characterizing is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal sections may be affected, which are separated by healthy sections.
  • Whipple’s disease (synonyms: Whipple’s disease, intestinal lipodystrophy; Engl.Whipplés disease) – rare systemic infectious disease; caused by the gram-positive rod bacterium Tropheryma whippelii (from the group of actinomycetes), which, in addition to the obligatorily affected intestinal system, can affect various other organ systems and is a chronic recurrent disease; symptoms: Fever, arthralgia (joint pain), brain dysfunction, weight loss, diarrhea (diarrhea), abdominal pain (abdominal pain), and more.

Musculoskeletal system and connective tissue (M00-M99).

  • Arthritis psoriatica (psoriatic arthritis; psoriatic arthritis).
  • Arthopathia psoriatica
  • Arthritis urica – joint inflammation based on a disorder of uric acid metabolism:
  • Osteoarthritis – degenerative joint disease.
  • Caplan syndrome – disease belonging to the pneumoconioses, which leads to arthritis in addition to rapidly growing round foci in the lungs.
  • Chondropathia patellae (“cartilage disease of the kneecap“).
  • Craniomandibular dysfunction (synonyms: CMD; CVD; cranio-vertebral dysfunction; craniomandibular dysfunction; myoarthropathy; myofacial dysfunction; TMDs; TMJ; temporo-mandibular joint disease; temporomandibular disorders) – term used to describe a variety of disorders of the temporomandibular joints, masticatory system, and associated tissues.
  • Dermatomyositis – idiopathic myopathy (muscle disease) or myositis (muscle inflammation) with skin involvement.
  • Purulent infections of the joints with arthralgias occur after open trauma (injuries) and by hematogenous spread of pathogens – eg in immunodeficiency (HIV, immunodeficiencies, diabetes mellitus, renal insufficiency (kidney weakness), malignant neoplasms / tumor diseases) or endoprostheses.
  • Felty syndrome – Severe course of rheumatoid arthritis, almost always rheumatoid factor-positive, occurring mainly in men between the ages of 20 and 40. Is accompanied by hepatosplenomegaly (liver and spleen enlargement), leukocytopenia (decrease in the number of white blood cells / leukocytes) and thrombocytopenia (decrease in the number of platelets / platelets).
  • Joint subluxations, recurrent (recurring).
  • Juvenile idiopathic arthritis (JIA; synonyms: juvenile rheumatoid arthritis (JRA), juvenile chronic arthritis, JCA) – chronic arthritis (inflammatory disease of the joints) of the rheumatic type in childhood (juvenile).
  • Bone marrow edema/bone marrow swelling (BMO)/bone marrow edema syndrome (BMOS) – term from magnetic resonance imaging (MRI). = edema-equivalent signal changes i.e. increased signal intensity (light) in T2-weighted sequences and decreased signal intensity (dark) in T1-weighted sequences in cancellous bone structures; acute pain and functional limitation of the affected joint; predilection sites (body regions where the disease occurs preferentially): Hip, knee, and upper ankle joints, the talus (ankle bone), and the os naviculare (navicular bone); DD osteonecrosis (ON; “bone death”), which, in contrast to CMOE, progresses rapidly; course is self-limiting (“ending without external influences”; 6-18 months); conservative therapy: Partial weight-bearing on the affected side with a pair of forearm crutches, analgesics (painkillers)/antiphlogistics (anti-inflammatory drugs), and physical therapy; if necessary as an off-label use (prescription of a finished drug outside the use approved by the drug authorities) Iloprost (rheologic) or bisphosphonates; if necessary, surgical therapy: drilling the bone (so-called “core decompression”) – patients with persistent joint pain that can not be explained by an accident or osteoarthritis or unclear joint pain.
  • Ankylosing spondylitis (synonyms: Ankylosing arthritis of the spine; Ankylosing spondylitis; Iridocyclitis in ankylosing spondylitis; Marie-Pierre disease; Marie-Strümpell spondylitis; Marie-von-Strümpell arthritis of the spine; Bekhterev’s disease; Primary progressive spinal arthritis; Rheumatoid spondylitis; Rheumatoid arthritis of the spine; Ankylosing spondylitis; Spondylitis ankylopoetica; Spondylitis ankylosans; Spondylitis rhizomélique; Spondylosis rhizomélique; Von Bechterew’s disease; Von Bechterew’s syndrome; Von Bechterew von Trümpell Marie disease; Von Bechterew von Trümpell Marie syndrome) – chronic inflammatory disease of the spine that can lead to joint stiffness (ankylosis) of the affected joints.
  • Patellar tendinitis (tendinitis patellaris, jumper’s knee, patellar tendinitis) – syndrome, which is counted among the painful and chronic overuse diseases; the extensor apparatus of the patella at the bone and tendon transition of the patellar tip is affected.
  • Polyarthritis (inflammation of five or more joints), viral (eg, after hepatitis, rubella).
  • Polymyositis (systemic inflammatory disease of skeletal muscles).
  • Primary vasculitides (including arteritis temporalis, panarteriitis nodosa, Wegner granulomatosis) – diseases of the rheumatic type.
  • Reactive arthritis (synonym: postinfectious arthritis / joint inflammation) – second disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; denotes an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of a “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
  • Rheumatoid arthritis (synonyms: chronic polyarthritis (CP), primary chronic polyarthritis (PCP)) – chronic inflammatory systemic disease which affects the periosteum (synovium) of the joints.
  • Sarcoidosis – inflammatory multisystem disease, the cause of which is still unclear.
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
  • Still’s syndrome (synonym: Still’s disease): systemic form of juvenile rheumatoid arthritis occurring in children with hepatosplenomegaly (enlargement of the liver and spleen), fever (≥ 39 °C, over 14 days), generalized lymphadenopathy (enlargement of the lymph nodes), carditis (inflammation of the heart), transient exanthema (skin rash), anemia (anemia). The prognosis of this disease is unfavorable.
  • Synovialitis (synovial inflammation).
  • Scleroderma – belongs to the group of autoimmune connective tissue diseases (collagenoses).
  • Systemic lupus erythematosus (SLE) – systemic autoimmune disease from the group of collagenoses.
  • Caisson disease

Neoplasms – tumor diseases (C00-D48)

  • Acute lymphoblastic leukemia (ALL)
  • Acute myeloid leukemia (AML)

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Decompression accident or illness (synonym: caisson disease).
  • Fracture (broken bone)
  • Traumatic lesions (injuries) of joints, of different genesis (cause).

Further

  • Alcohol abuse (alcohol dependence)

Medication

Environmental pollution – intoxications (poisonings).

  • Electromagnetic sensitivity [?]

Further

  • Professions – professions with
    • Heavy labor (e.g. construction).
    • Carrying and lifting heavy loads (eg, construction, parcel services).
    • Impacts of vibrations on the body (eg, rammers, drills).
    • Working in a seated position (eg, office workers).
    • Work with increased exertion or application of force.
    • Work in unfavorable posture (forced posture) (eg floor layers, screed layers, hairdressers, watchmakers).
    • Constantly repetitive work (eg, assembly line workers).