Arthralgia

Arthralgia
ICD-10	M25.5
ICD-9	719.4
DiseasesDB	15237
MeSH	D018771

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Overview

Arthralgia (from Greek arthro-, joint + -algos, pain) literally means joint pain; it is a symptom of injury, infection, illnesses -- in particular arthritis-- or an allergic reaction to medication.

According to MeSH, the term "arthralgia" should only be used when the condition is non-inflammatory, and the term "arthritis" should be used when the condition is inflammatory.

Diagnosis and Causes

Diagnosis involves interviewing the patient and performing physical exams. When attempting to establish the cause of the arthralgia, the emphasis is on the interview . The patient is asked questions intended to narrow the number of potential causes. Given the varied nature of these possible causes, the questions may strike the uninitiated as irrelevant. For example the patient may be asked about dry mouth, light sensitivity, rashes or a history of seizures. Answering yes or no to any of these questions limits the number of possible causes and guides the doctor toward the appropriate exams and lab tests.

The causes of arthralgia are varied and range from, a joints perspective, degenerative and destructive processes such as osteoarthritis and sports injuries to inflammation of tissues surrounding the joints (e.g. bursitis, a painful inflammation of bursa, fluid filled sacks around the joints).

Treatment

Treatment depends on specific underlying cause. The underlying cause will be treated first and foremost. The treatments may include joint replacement surgery, for severely damaged joints, immunosuppressants for immune system dysfunction, antibiotics when an infection is the cause, and discontinuing medication when an allergic reaction is the cause. When treating the primary cause, pain management may still play a role in treatment. The extent of its role varies depending on the specific cause of the arthralgia. Pain management may include stretching exercises, over the counter pain medications, prescription pain medication, or other treatments deemed appropriate for the symptoms.

Complete Differential Diagnosis of the Causes of Arthralgia

(In alphabetical order)

• Acute lymphoblastic leukemia
• Acromegaly
• Acute myeloid leukemia
• Acute promyelocytic leukemia
• Adhesive capsulitis of shoulder
• Alkhurma virus
• Ankylosing spondylitis
• Arthrofibrosis
• Atypical pneumonia
• Autoimmune Hepatitis
• Avascular necrosis
• Baker's cyst
• Barmah Forest virus
• Behcet's disease
• Bismuth
• Blau syndrome (granulomatous arthritis, iritis, and skin rash)
• Borrelia burgdorferi (Lyme Disease)
• Bruton's agammaglobulinemia
• Bursitis
• Caplan's disease (rheumatoid arthritis and pneumoconiosis)
• Carbimazole
• Celiac Sprue
• Chikungunya virus
• Chlamydia trachomatis
• Chronic fatigue syndrome
• Ciprofloxacin (Quinolone-induced cartilage toxicity in children)
• Coccidioidomycosis lung infection
• Coeliac disease
• Community-acquired pneumonia
• Complex regional pain syndrome
• Crohn's disease
• Cryoglobulinaemia
• Decompression sickness
• Deferiprone
• Dengue fever
• Diffuse idiopathic skeletal hyperostosis
• Diastasis symphysis pubis
• Dressler's syndrome
• Ebola
• Ehlers-Danlos syndrome
• Erythema nodosum
• Erythema elevatum diutinum (is a rare type of leukocytoclastic vasculitis characterized by red, purple, brown, or yellow papules, plaques, or nodules)
• Familial Mediterranean fever
• Farber's disease
• Fibromyalgia
• Fluorosis
• Fracture of bone
• Gamekeeper's thumb
• Gaucher's disease
• Giant cell tumor of bone
• Gluten-sensitive enteropathy associated conditions
• Golfer's elbow
• Gonorrhea
• Gout
• Graft versus host disease
• Haemochromatosis
• Haemophilia type A
• Henoch-Schönlein purpura
• Hepatitis A, B, C
• Hereditary multiple exostoses
• Hip dysplasia, congenital
• Hurler syndrome
• Hyperimmunoglobulinemia D and periodic fever syndrome ( attacks of fever, arthralgia, skin lesions, and diarrhea)
• Hypertrophic pulmonary osteoarthropathy
• Hypothyroidism
• Iliotibial band syndrome
• Interstitial nephritis
• Isotretinoin
• Jacobs arthropathy-camptodactyly syndrome
• Juvenile chronic arthritis
• Kawasaki disease
• Kikuchi disease
• Kniest dysplasia
• Legg-Calve-Perthes syndrome
• Lepromatous leprosy
• Leukemia
• Ligamentous laxity
• Limb-girdle muscular dystrophy
• Lipoid dermatoarthritis
• Lupus erythematosus
• Lyme disease
• Malaria
• Marfan syndrome
• Mayaro virus fever

Metal fume fever

• Methimazole
• Mianserin (antidepressant, also mirtazapine and nefazodone are associated with arthralgia)
• Mixed connective tissue disease
• Morphoea/scleroderma
• Multiple epiphyseal dysplasia: Recessive Multiple Epiphyseal Dysplasia
• Multiple myeloma

Muscular dystrophy

• Mycoplasma pneumoniae
• Nalidixic acid
• Nateglinide

Neuropathic joint disease Noonan's Syndrome

• Norfloxacin
• Obesity
• O'nyong-nyong fever
• Osteoarthritis
• Osteochondritis dissecans

Osteoporosis Otospondylomegaepiphyseal dysplasia

• Paget's disease of bone
• Palindromic rheumatism (idiopathic, periodic arthritis marked by multiple and recurrent attacks affecting one to a few joints, with tissue inflammation around or adjacent to them)
• PAPA syndrome ( Pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome)
• Parvovirus B19 infection
• Pharyngitis
• Pigmented villonodular synovitis
• Pituitary tumour (*Acromegaly, growth hormone secreting tumor)

Piriformis syndrome Plantar fasciitis pneumoconiosis]]) Poliomyelitis

• Polyarteritis nodosa
• Polychondritis, Relapsing
• Progressive pseudorheumatoid dysplasia
• Propylthiouracil

Psoriasis

• Pyoderma gangrenosum
• Pyrazinamide
• Pyrophosphate arthropathy (Pseudogout)
• Rat bite fever (Streptobacillus moniliformis or Spirillum minus)

Reactive arthritis Recessive Multiple Epiphyseal Dysplasia]]

• Recurrent hereditary polyserositis

Relapsing fever Renal osteodystrophy Retropatellar Pain Syndrome

• Rheumatic Fever
• Rheumatoid arthritis

Rocky Mountain spotted fever

• Ross River virus
• Rubella
• Sarcoidosis
• Scleroderma

Scoliosis Secondary hyperparathyroidism Semliki forest fever

• Sclerosing osteomyelitis of Garre
• Secondary syphilis
• Semliki forest fever
• Serum sickness
• Sickle cell disease
• Sjögren's syndrome

Slipped Upper Femoral Epiphysis Soft tissue sarcoma Spondylitis Spondylolisthesis Spondylosis

• Stickler syndrome
• Still's Disease, Juvenile-Onset

Subacromial bursitis

• Sweet's disease

Symphysis pubis dysfunction

• Synovial chondromatosis
• Systemic sclerosis
• Takayasu's arteritis

Tennis elbow Tenosynovitis Thrombotic thrombocytopenic purpura

• Toxic shock syndrome
• Trastuzumab
• Trichinosis

Tuberculosis Tularemia

• Ulcerative Colitis

Viral Hepatitis B Viral Hepatitis C Viral Hepatitis D

• Urate crystal arthropathy (gout)
• Waldenström macroglobulinemia
• Wegener's granulomatosis
• West Nile fever
• Whipple disease
• Wilson's disease
• Wissler-Fanconi syndrome

Wissler-Fanconi syndrome Yellow fever Yersinia enterocolitica Infection (Yersiniosis) Yersinia pseudotuberculosis Zika fever

• Zotepine

Complete Differential Diagnosis of the Causes of Arthralgia

(By organ system)

Cardiovascular	Dressler's syndrome
Chemical / poisoning	No underlying causes
Dermatologic	Blau syndrome, Ehlers-Danlos syndrome, Erythema elevatum diutinum, Lepromatous leprosy, Lipoid dermatoarthritis, Lupus erythematosus, Lyme disease Mixed connective tissue disease, scleroderma, PAPA syndrome, Pyoderma gangrenosum, Rheumatic Fever, Scleroderma, syphilis, Sweet's disease, Systemic sclerosis, Erythema nodosum
Drug Side Effect	Bismuth, Carbimazole, Ciprofloxacin, Deferiprone, Fluorosis, Isotretinoin, Methimazole, Mianserin, mirtazapine, nefazodone, Nalidixic acid, Nateglinide, Norfloxacin, Propylthiouracil, Pyrazinamide, Trastuzumab, Zotepine, Avascular necrosis
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, Obesity, Avascular necrosis
Environmental	No underlying causes
Gastroenterologic	Coeliac disease, Crohn's disease, Hepatitis A, B, C, Ulcerative Colitis, Whipple disease, Wilson's disease, Autoimmune Hepatitis, Celiac Sprue
Genetic	Ankylosing spondylitis, Celiac Sprue, Gaucher's disease, Hereditary multiple exostoses, Legg-Calve-Perthes syndrome, Limb-girdle muscular dystrophy, Marfan syndrome
Hematologic	Haemochromatosis, Haemophilia type A, Henoch-Schönlein purpura, Acute myeloid leukemia, Acute promyelocytic leukemia, Leukemia
Iatrogenic	*Arthrofibrosis,
Infectious Disease	Atypical pneumonia, Borrelia burgdorferi, Lyme Disease, Chikungunya virus, Coccidioidomycosis lung infection, Community-acquired pneumonia Hepatitis A; B; C, Lepromatous leprosy, Lyme disease, Malaria, Mayaro virus fever, Mycoplasma pneumoniae, O'nyong-nyong fever, Parvovirus B19 infection, Pharyngitis, Rat bite fever, Rheumatic Fever, Ross River virus, Rubella, syphilis, Semliki forest fever, Serum sickness, Toxic shock syndrome, Trichinosis, West Nile fever, Whipple disease, Barmah Forest virus, Chlamydia trachomatis, Dengue fever, Ebola, Gonorrhea
Musculoskeletal / Ortho	Blau syndrome, Borrelia burgdorferi, Fibromyalgia, Gout, congenital Hip dysplasia, Hypertrophic pulmonary osteoarthropathy, Jacobs arthropathy-camptodactyly syndrome, Juvenile idiopathic arthritis, Lipoid dermatoarthritis, Lupus erythematosus, Lyme disease, Mixed connective tissue disease, Multiple epiphyseal dysplasia, Osteoarthritis, Osteochondritis dissecans, Paget's disease of bone, Palindromic rheumatism, PAPA syndrome, Pigmented villonodular synovitis, Polyarteritis nodosa, Polychondritis, Relapsing, Progressive pseudorheumatoid dysplasia, Pseudogout, Recurrent hereditary polyserositis, Rheumatoid arthritis, Scleroderma, Sclerosing osteomyelitis of Garre, Sjögren's syndrome, Still's Disease, Synovial chondromatosis, Systemic sclerosis, Takayasu's arteritis, gout, Adhesive capsulitis of shoulder, Ankylosing spondylitis, Arthrofibrosis, Avascular necrosis, Baker's cyst, Bursitis, Erythema nodosum, Marfan syndrome
Neurologic	No underlying causes
Nutritional / Metabolic	Obesity
Obstetric/Gynecologic	No underlying causes
Oncologic	Acute lymphoblastic leukemia, Multiple myeloma, Pigmented villonodular synovitis, Acute myeloid leukemia, Acute promyelocytic leukemia, Giant cell tumor of bone, Hereditary multiple exostoses, Hurler syndrome, Leukemia
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Atypical pneumonia, Caplan's disease, Coccidioidomycosis lung infection, Community-acquired pneumonia, Mycoplasma pneumoniae
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	"|Behcet's disease, Caplan's disease, Coeliac disease, Crohn's disease, Dressler's syndrome, Erythema elevatum diutinum, Hypothyroidism, Juvenile chronic arthritis, Lupus erythematosus, Mixed connective tissue disease, Polyarteritis nodosa, Polychondritis, Relapsing Pyoderma gangrenosum, Rheumatic Fever, Rheumatoid arthritis, Sarcoidosis, Scleroderma , Serum sickness, Sjögren's syndrome, Still's Disease, Systemic sclerosis, Takayasu's arteritis, Takayasu's arteritis, Wegener's granulomatosis, Ankylosing spondylitis, Autoimmune Hepatitis, Celiac Sprue, Erythema nodosum, Familial Mediterranean fever, Iliotibial band syndrome
Sexual	No underlying causes
Trauma	Bursitis, Complex regional pain syndrome, Diastasis symphysis pubis, Golfer's elbow
Urologic	No underlying causes
Miscellaneous	Complex regional pain syndrome, Familial Mediterranean fever, Kikuchi disease