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Anasarca

2009-09-21T22:28:24Z

Johnfanisrour:

{{Infobox_Disease |
Name = Anasarca |
Image = Anasarca_002.jpg |
Caption = CT scan showing generalized edema of skin |
ICD10 = {{ICD10|R|60|1|r|50}} |
ICD9 = {{ICD9|782.3}} |
}}
{{CMG}}
{{JFS}}

{{SI}}

{{EH}}

{{SK}} Generalized edema, leucophlegmatia

==Overview==
'''Anasarca''' is a [[list of medical symptoms|medical symptom]] characterized by widespread swelling of the [[skin]] due to effusion of fluid into the [[extracellular space]]. Anasarca is often due to either congestive [[cardiac failure]], [[liver failure]] ([[cirrhosis]] of the liver), [[renal failure]]/disease, or the other diseases listed below. Plant-derived anticancer [[chemotherapy|chemotherapeutic]] agents, such as [[docetaxel]], cause anasarca through a poorly understood [[capillary leak syndrome]].

== '''Complete Differential Diagnosis of the Causes of Anasarca:''' ==

(In alphabetical order)

*[[Acute renal failure]], especially oliguric renal failure with fluid retention
*[[Allergic reactions]], only systemic severe allergic reactions with associated capillary leak
*[[Angioedema]], rarely, when it is severe and generalized
*[[Burns]] (generalized severe burns can result in [[Hypoalbuminemia]] and capillary leak)
*[[Calcium channel blockers]] usually cause localized edma and not anasarca
*[[Capillary leak syndrome]]
*[[Cardiac tamponade ]] resulting in heart failure and generalized edema
*[[Chronic kidney disease]] (advanced stages with fluid retention)
*[[Constrictive pericarditis]] with associated heart failure
*[[Cor pulmonale]] resulting in right heart failure
*[[Diazoxide]] usually cause localized edma and not anasarca
*Corticosteriods
*[[Dilated cardiomyopathy]]
*[[Docetaxel]] usually cause localized edma and not anasarca
*[[Eclampsia]] (severe eclampsia)
*[[Effusive-constrictive pericarditis]] with associated heart failure
*[[Estrogens]]
*[[Fludrocortisone]]
*[[Glomerulonephritis]]
*[[Haemolytic disease of the newborn]]
*[[Heart failure]]
*Hepatic [[cirrhosis]]
**[[Alcoholic liver disease]]
**[[Alpha-1-antitrypsin deficiency]]
**[[Autoimmune hepatitis]]
**Chronic [[hepatitis B]]
**Chronic [[hepatitis C]]
**Hepatic venous obstruction
**[[Hereditary hemochromatosis]]
**[[Primary biliary cirrhosis]]
**[[Primary sclerosing cholangitis]]
**[[Non-alcoholic fatty liver disease|Nonalcoholic fatty liver disease]]
**[[Wilson's disease]]
*[[Hereditary angioedema]] in severe cases
*[[Hypertrophic cardiomyopathy]]
*[[Hypoalbuminemia]]
*[[Hypoproteinemia]]
*[[Hypothyroidism]] (advanced untreated hypothyroidism)
*Idiopathic [[edema]]
*[[Increased capillary permeability]]
*Increased interstitial oncotic pressure
*[[Interleukin-2]] therapy
*[[Kwashiorkor]]
*Lymphatic obstruction usually cause localized limb [[edema]] unless very proximal
*[[Malnutrition]]
*[[Malignant ascites]] is usually associated with lower extremities edema
*[[Minoxidil]] usually causes localized edema to the lower extremities
*[[Nephrotic syndrome]]
*[[Nonsteroidal antiinflammatory drug]] causes localized edma
*[[Ovarian hyperstimulation syndrome]]
*[[POEMS syndrome]]
*[[Portal thrombosis]] causes lower extremities edema
*[[Pramipexole]]
*[[Pregnancy]]
*Protein loss
*[[Protein-losing enteropathy]]
*Reduced [[albumin]] synthesis
*[[Refeeding]] edema
*[[Restrictive cardiomyopathy]]
*Severe inflammation or [[sepsis]]
*Sodium overload
*[[Thiazolidinediones]]
*[[Trauma]] (severe trauma)
*[[Tricuspid stenosis]]
*[[Tropical sprue]]
*Venous obstruction usually causes localized edema in the limb
*[[Water overload]]
*[[Yellow nail syndrome]]

== '''Complete Differential Diagnosis of the Causes of Anasarca''': ==
(By organ system)
{|style="width:75%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac tamponade ]], [[Constrictive pericarditis]], [[Cor pulmonale]], [[Dilated cardiomyopathy]], [[Effusive-constrictive pericarditis]], [[Heart failure]], [[Hypertrophic cardiomyopathy]], [[Restrictive cardiomyopathy]], [[Tricuspid stenosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Calcium channel blockers]], [[Diazoxide]], [[Docetaxel]], [[Estrogens]]
[[Fludrocortisone]], Interleukin-2 therapy, [[Minoxidil]], Nonsteroidal antiinflammatory drugs, Corticosteriods
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| Corticosteriods
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Water intoxication]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Alcoholic liver disease ]], [[Autoimmune hepatitis]], [[Chronic hepatitis B]], [[Chronic hepatitis C]], [[Hepatic cirrhosis]], [[Hepatic venous obstruction]], [[Hereditary hemochromatosis]], [[Portal thrombosis]], [[Primary biliary cirrhosis]], [[Primary sclerosing cholangitis]], [[Wilson's disease]]

|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Angioedema]], [[Alpha-1-antitrypsin deficiency]], [[Hereditary angioedema]]
[[Hereditary hemochromatosis]], [[Hypertrophic cardiomyopathy]], [[Wilson's disease]], [[Yellow nail syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Water intoxication]], excess intravenous fluids
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Tropical sprue]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Hypoalbuminemia]], Hypoproteinaemia, [[Kwashiorkor]], [[Malnutrition]]
Protein loss, [[Protein-losing enteropathy]], Reduced albumin synthesis, Refeeding edema, Sodium overload, [[Tropical sprue]], Water overload
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Eclampsia]], [[Estrogens]], [[Haemolytic disease of the newborn]], [[Ovarian hyperstimulation syndrome]], [[Pregnancy ]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Malignant ascites]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Water intoxication]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Nephrotic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Haemolytic disease of the newborn]], [[Autoimmune hepatitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
 
 

=='''Treatment'''==

The treatment of anasraca depends on the underlying cause. It involves the use of [[diuretic]]s in cases related to [[heart failure]] or kidney disease. The latter may require [[hemodialysis]] especially if there are signs or symptoms of [[uremia]]. In cases of severe [[burns]] resulting in [[hypoalbuminemia]] and [[capillary leak]], admission to a burn unit, volume and [[electrolyte]] replacement, and adequate nutrition is of paramount. Withdrawal of the offending drug is critical in drug-induced anasarca. The use of diuretics, [[paracentesis]], and adequate nutritional supplementation is needed in anasarca secondary to [[hepatic cirrhosis]]. Profound [[hypothyroidism]] requires thyroid hormone replacement. Protein [[malabsorption]] syndromes require the identification of the underlying disease process and adequate protein supplementation.

[[Category:Signs and symptoms]]

{{SIB}}
{{WH}}
{{WS}}

Abdominal mass

2009-09-21T22:27:06Z

Johnfanisrour:

{{Infobox_Disease
| Name = {{PAGENAME}}
| Image = Abdominal mass 1.jpg
| Caption = This infant has massive hepatomegaly due to metastatic neuroblastoma. Intra-abdominal pressure is partially relieved by a silastic pouch. [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] 
| DiseasesDB =
| DasesDB_mult =
| ICD10 =
| ICD9 =
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| eMedicine_mult =
| MeshID =
}}
{{SI}}
{{CMG}}
{{JFS}}
{{Editor Join}}

==Overview==

An '''abdominal mass''' is any localized enlargement or [[swelling]] in the [[human abdomen]]. Depending on its location, the abdominal mass may be caused by an enlarged [[liver]] ([[hepatomegaly]]), enlarged [[spleen]] ([[splenomegaly]]), protruding [[kidney]], a [[Pancreas|pancreatic mass]], a [[Retroperitoneum|retroperitoneal mass]] (a mass in the [[posterior ]] of the [[peritoneum]]), an [[abdominal aortic aneurysm]], or various [[tumour]]s, such as those caused by abdominal [[carcinomatosis]] and [[omental]] [[metastasis]]. The [[treatment]]s depend on the cause, and may range from [[watchful waiting]] to radical [[surgery]].

==Features==
Many '''abdominal mass'''es are discovered incidentally during routine [[physical examination]]. When they present [[symptom]]atically, '''abdominal mass'''es are most frequently associated with [[Pain and nociception|pain]] or digestive problems. However, depending on the cause, masses may be associated with other [[sign (medical)|sign]]s and symptoms, such as [[jaundice]] or [[bowel obstruction]].

==Diagnosis==
The first steps in diagnosis are a [[medical history]] and physical examination. Important clues during history include [[weight loss]], [[diarrhea]] and [[abdominal pain]].

During physical examination, the clinician must identify the location of the mass, as well as characterize its location (usually specified in terms of quadrants). The mass should be assessed for whether it is rigid or mobile. It should also be characterized for pulse or [[peristalsis]], as these would help in further identifying the mass.

Routine [[blood test]]s are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a [[full blood count]], [[blood urea nitrogen]] ([[BUN]]), [[creatinine]], and [[liver function tests]] such as [[Liver function tests#Albumin (Alb)|albumin]], [[international normalized ratio]] ([[INR]]), [[partial thromboplastin time]] ([[PTT]]), [[serum amylase]] and [[Liver function tests#Total bilirubin (TBIL)|total bilirubin]] ([[TBIL]]). If late-stage [[liver disease]] is suspected, then a [[Liver function tests#Serum glucose (BG, Glu)|serum glucose]] may be appropriate.

==Complete Differential Diagnosis of Causes of Abdominal Mass==

In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

*[[Abdominal Aortic Aneurysm]]
*[[Abscess]]
*[[Actinomyces]]
*[[Acute pancreatitis]]
*[[Adrenal tumor]]
*[[Alveolar hydatid disease]] (parasite mass, most commonly involving the liver)
*[[Amyloidosis]] (hepatomegaly and splenomegaly)
*[[Aneurysms]]
*[[Ascites]] (localized ascites)
*[[Autoimmune pancreatitis]] (inflammatory mass)
*[[Bezoar]]
*[[Biliary atresia]]
*[[Bladder]] distention
*[[Blind loop syndrome]] ( the mass is the loop of the bowel)
*[[Bowel obstruction]] (the mass is a loop of the obstructed bowel)
*[[Brenner tumor]] (ovarian tumor)
*[[Burkitt's lymphoma]]
*[[Carcinoid tumours]]
*[[Cholangiocarcinoma]]
*[[Cholecystitis]] ( inflammatory mass, or abscess)
*[[Choledochal cyst]]
*[[Cholelithiasis]] ( a stone filled gallbladder can produces a painless right-upper-quadrant mass)
*[[Choriocarcinoma]]
*[[Chronic myelogenous leukemia]] (splenomegaly)
*[[Cirrhosis]] ( the liver itself or one significantly enlarged nodule) C66
*[[Colonic diverticulitis]] (inflammatory mass or peridiverticular abscess)
*[[Colorectal cancer]]
*[[Congenital megacolon]] ([[Hirschsprung's disease]])
*[[Constipation]] (fecal mass or dilated colon)
*[[Crohn's disease]] ( abscess, loop of obstructed bowel, or inflammatory mass with or with out fistula)
*[[Cryptorchidism]]
*[[Dermoid cyst]]
*[[Desmoplastic small round cell tumor]] ( soft tissue sarcoma, usually multiple abdominal masses)
*[[Distal intestinal obstruction syndrome]] ( in patients with cystic fibrosis or pancreatic enzymes insufficiency)
*[[Ectopic pregnancy]]
*[[Endodermal sinus tumor]]
*[[Endometriosis]]
*[[Entamoeba histolytica]] (hepatomegaly and splenomegaly)
*[[Eosinophilic gastroenteritis]] ( rare presentation as an obstructing caecal mass)
*Extramedullary [[hematopoiesis]] (splenomegaly)
*[[Gallbladder cancer|Gallbladder benign tumors]]
*[[Gallbladder cancer]]
*[[Gallbladder empyema]]
*[[Gastrointestinal stromal tumor]]
*[[Gastroschisis]] ( other names paraomphalocele, laparoschisis, or abdominoschisis)
*[[Germ cell tumor]]
*[[Hamartoma]]
*[[Hemangioendothelioma]]
*[[Hemangiopericytoma]]
*[[Hepatic adenoma]]
*[[Hepatoblastoma]]
*[[Hepatomegaly]]
**4-hydroxyphenylpyruvate hydroxylase deficiency
**Alpha-L-iduronidase deficiency (Hurler syndrome)
**Alpha-L-iduronidase deficiency (Hurler-Scheie syndrome)
**Alpha-mannosidase deficiency
**[[Amyloidosis ]]
**Apolipoprotein C-II deficiency
**Arginosuccinate synthetase deficiency
**Arginosuccinic aciduria
**Autoimmune lymphoproliferative syndrome type 1
**Autoimmune lymphoproliferative syndrome type 2
**Berardinelli lipodystrophy syndrome
**Carnitine palmitoyltransferase 1 deficiency
**Castleman disease
**Cerebrohepatorenal syndrome
**Chanarin-Dorfman disease
**[[Chediak-Higashi disease ]]
**[[Cholesterol ester storage disease ]]
**[[Coproporphyria, hereditary ]]
**[[Cystic fibrosis ]]
**Dibasic aminoaciduria type 2
**Extramedullary haemopoiesis
**Familial alphalipoprotein deficiency
**Familial histiocytic reticulosis
**Familial hypertriglyceridaemia
**Fanconi-Bickel syndrome
**Farber lipogranulomatosis
**Fructose-1, 6-diphosphatase deficiency
**Fructose-1-phosphate aldolase deficiency
**[[ Fucosidosis ]]
**[[Fumarase deficiency ]]
**Galactose epimerase deficiency
**[[Galactose-1-phosphate uridyltransferase deficiency ]]
**Gangliosidosis GM1, type 1
**Gangliosidosis GM1, type 3
**Gangliosidosis GM3
**[[Gaucher disease ]]
**Geleophysic dysplasia
**[[Glutaric acidemia type 2 ]]
**Glycine N-methyltransferase deficiency
**Glycogenosis type 1a
**Glycogenosis type 1b
**Glycogenosis type 2
**Glycogenosis type 3
**Glycogenosis type 6
**Glycogenosis type 8
**[[Haemochromatosis ]]
**Hepatic [[hemangioma ]]
**Hepatic venoocclusive disease with immunodeficiency ]]
**Hepatocellular jaundice]]
**[[I-cell disease ]]
**Iduronate-2-sulfatase deficiency
**[[Iminodipeptiduria ]]
**[[Lipoprotein lipase deficiency ]]
**Liver [[granuloma]]
**Long chain hydroxyacyl-CoA dehydrogenase deficiency
**Long-chain Acyl-CoA dehydrogenase deficiency
**Mucopolysaccharidosis type IVB
**[[Mucopolysaccharidosis VI ]]
**[[Myelofibrosis ]]
**Niemann-Pick disease type B
**Niemann-Pick Disease, Type C
**Norrbottnian Gaucher disease
**Osteopetrosis (malignant)
**Osteopetrosis (malignant)
**Plasma membrane carnitine transporter deficiency
**[[POEMS syndrome ]]
**[[Polycystic kidney disease]]
**[[Polycystic liver disease ]]
**Riedel lobe of liver
**[[Salla disease ]]
**[[Sandhoff disease ]]
**Sanfilippo disease
**[[Sickle cell crisis ]]
**Sphingomyelinase deficiency
**[[Syphilis]], congenital
**Toxoplasma, congenital
**Very long-chain acyl-CoA dehydrogenase deficiency
**[[Visceral larva migrans]]
**[[Wilson disease]]
**Wolcott-Rallison syndrome
**Zimmermann-Laband syndrome
*[[Hernia]]
*[[Hirschsprung's disease]] (congenital megacolon)
*[[Hodgkin's lymphoma]]
*[[Hydatid cyst]]
*[[Hydronephrosis]]
*[[Intususception]] of the intestine
*[[kala-azar]] or [[Leishmaniasis]] (splenomegaly)
*[[Kaposi sarcoma]]
*[[Kidney cancer]] (including renal cell carcinoma)
*[[Krukenberg tumor]] (secondary ovarian malignancy whose primary site arose in the gastrointestinal tract)
*[[Large bowel obstruction]]
*[[Leiomyoma]]
*[[Liposarcoma]](retroperitoneal)
*[[Liver abscess]]
*[[Liver cancer|Liver cancer, metastatic]]
*[[Liver cancer|Liver cancer, primary]] ([[hepatocellular carcinoma]])
*Liver [[granuloma]]
*[[Lymphogranuloma venereum]]
*[[Meigs syndrome]] (ovarian tumor)
*Mesenteric cyst
*[[Mesothelioma]] ( abdominal )
*Mucosal-associated lymphoid tissue lymphoma (MALTOMA)
*[[Mycobacterium tuberculosis]] (hepatomegaly and splenomegaly)
*[[Nephroblastoma]]
*[[Neurilemmoma]]
*[[Neuroblastoma]]
*[[Neuroendocrine tumor]]
*[[Neurofibromatosis]]
*[[Non-Hodgkin lymphoma]]
*[[Obesity]] ( subcutaneous fat mass)
*[[Oesophagostomiasis]] ( a parasitic intestinal helminth that develops in the colonic wall, causing pus-filled granulomas)
*[[Ogilvie's Syndrome]] (dilated loop of bowels)
*[[Oncocytoma]] (of the kidney)
*[[Ovarian cancer]]
*[[Ovarian cyst]]
*[[Courvoisier's law|Palpable gallbladder]] ([[Courvoisier's law|Courvoisier's sign]])
*Pancreatic [[abscess]]
*[[Pancreatic cancer]]
*[[Pancreatic islet cell tumors ]]
*[[Pancreatic pseudocyst]]
*[[Pelvic inflammatory disease]] (abscess)
*[[Pelvic kidney]]
*[[Peritoneal adhesions]]
*[[Phaeochromocytoma]]
*[[Plexosarcoma]]
*[[Polycystic kidney disease]]
*[[Pregnancy]]
*[[Prune belly syndrome]]
*[[Pseudomyxoma peritonei]]
*[[Pyloric stenosis]]
*[[Rectus sheath hematoma]]
*[[Renal cell carcinoma]]
*[[Renal oncocytoma]]
*[[Renal transplantation]] (the mass is the transplanted kidney)
*[[Rhabdoid tumor]]
*Riedel lobe of liver (sessile accessory lobe of the liver, a normal variant)
*[[Sacrococcygeal teratoma]]
*[[Sarcoidosis]] ( granulomatus mass, [[hepatomegaly]], or [[splenomegaly]]
*[[Sickle cell crisis]] (abdominal / sequestration)
*[[Sister Mary Joseph nodule]]
*Small bowel [[lymphoma]]
*[[Small bowel obstruction]]
*[[Small intestine cancer]]
*Spleen [[lymphoma]]
*[[Splenomegaly]]
**[[Acanthocheilonemiasis ]]
**Adult T cell leukemia
**Alpha-L-iduronidase deficiency (Hurler syndrome)
**Alpha-L-iduronidase deficiency (Hurler-Scheie syndrome)
**Alpha-mannosidase deficiency
**[[Amyloidosis]]
**Angioimmunoblastic lymphadenopathy with dysproteinaemia
**Apolipoprotein C-II deficiency
**Autoimmune lymphoproliferative syndrome type 1
**Autoimmune lymphoproliferative syndrome type 2
**[[Babesiosis ]]
**[[Bartonellosis ]]
**Beta [[thalassaemia]] (heterozygous)
**[[Brucellosis ]]
**Cardiac failure, right sided
**Castleman disease
**[[Cat scratch fever ]]
**Chanarin-Dorfman disease
**[[Chediak-Higashi disease ]]
**[[Cholesterol ester storage disease ]]
**[[Chronic lymphocytic leukaemia ]]
**[[Chronic myeloid leukaemia ]]
**Common variable hypogammaglobulinaemia
**Congenital dyserythropoietic anaemia type 1
**Congenital erythropoeitic porphyria
**[[Coproporphyria, hereditary ]]
**Cruveilhier-Baumgarten syndrome
**[[Dengue ]]
**[[Endocarditis ]]
**[[Epstein-Barr virus ]]
**Extramedullary haemopoiesis
**Familial alphalipoprotein deficiency
**Familial histiocytic reticulosis
**Familial hypertriglyceridaemia
**Farber lipogranulomatosis
**[[Filgrastim ]]
**[[Fucosidosis ]]
**[[Fumarase deficiency ]]
**Galactose epimerase deficiency
**[[Galactose-1-phosphate uridyltransferase deficiency ]]
**[[Gamma heavy chain disease ]]
**Gangliosidosis GM1, type 1
**Gangliosidosis GM1, type 3
**Gangliosidosis GM3
**[[Gaucher disease ]]
**Geleophysic dysplasia
**Glucose phosphate isomerase deficiency
**Glycogenosis type 4
**Granulocyte colony stimulating factor
**[[Haemochromatosis ]]
**Haemoglobin C disease
**Haemoglobin E disease
**Haemoglobin SC disease
**[[Haemolytic disease of the newborn]]
**[[Hairy cell leukaemia ]]
**Hepatic portal vein obstruction
**Hepatic vein thrombosis
**[[Hepatitis B ]]
**[[Hereditary spherocytosis ]]
**[[Histiocytosis X ]]
**[[Hodgkin lymphoma ]]
**[[I-cell disease ]]
**Iduronate-2-sulfatase deficiency
**[[Iminodipeptiduria ]]
**[[Infectious mononucleosis ]]
**Juvenile chronic arthritis
**[[Kartagener syndrome ]]
**Long chain hydroxyacyl-CoA dehydrogenase deficiency
**Macrophage activation syndrome
**Malaria (benign quartan)
**Malaria (benign tertian)
**Malaria (malignant tertian)
**[[Mastocytosis ]]
**McLeod phenotype
**Mevalonate kinase deficiency
**Mixed essential cryoglobulinaemia
**mu chain disease
**[[Mucopolysaccharidosis VI ]]
**[[Myelofibrosis ]]
**[[Myeloma ]]
**Neutrophilia, hereditary
**Niemann-Pick disease type B
**Niemann-Pick Disease, Type C
**[[Non-Hodgkin lymphoma]]
**Norrbottnian Gaucher disease
**Osteopetrosis (malignant)
**[[Paragonimiasis ]]
**[[Polycythaemia rubra vera ]]
**Primary autoimmune haemolytic anaemia
**[[Primary biliary cirrhosis ]]
**Primary thrombocythemia, acquired
**[[Psittacosis ]]
**[[Relapsing fever ]]
**[[Rickettsiae ]]
**[[Rubella]]
**[[Salla disease ]]
**[[Sandhoff disease ]]
**Sanfilippo disease
**[[Sarcoidosis ]]
**[[Schistosoma haematobium ]]
**[[Schistosoma mansoni ]]
**[[Sea blue histiocytosis ]]
**[[Serum sickness]]
**[[Sickle cell disease]]
**Sleeping sickness (East African)
**Sleeping sickness (West African)
**Sphingomyelinase deficiency
**Still disease, adult-onset
**Still Disease, Juvenile-Onset
**Syphilis, congenital
**[[Systemic lupus erythematosus]]
**[[Tertiary syphilis ]]
**[[Toxocariasis]]
**[[Toxoplasma ]]
**Toxoplasma, congenital
**[[Trench fever ]]
**[[Typhus fever ]]
**Tyrosinaemia type 1
**[[Visceral larva migrans]]
**[[Visceral leishmaniasis]]
**[[Vitamin B12 deficiency]]
**Waldenström macroglobulinaemia
**[[Whipple disease]]
**Zimmermann-Laband syndrome
*[[Splenosis]] (autotransplantation of splenic tissues, usually after splenic rupture)
*[[Stomach cancer]]
*[[Syphilis]](congenital)
*[[Tertiary syphilis]] (mass, hepatomegaly, and splenomegaly)
*[[Toxic megacolon]]
*[[Toxoplasmosis]](congenital)
*[[Transitional cell carcinoma]] (bladder)
*[[Urachal cyst]] (a sinus remaining from the allantosis during embryogenesis)
*[[Ureteropelvic junction obstruction]] (pediatric hydronephrosis and palpable kidneys)
*[[Urine retention]] (distended bladder)
*Uterine enlargement
*Uterine [[leiomyoma]] (fibroids)
*[[Varicocele]]
*[[Vermiform appendix]]
*[[Visceral larva migrans]]
*[[Volvulus]] (twisted piece of the gastrointestinal tract)
*[[Wandering spleen]]
*Wilm's tumor (pediatric renal tumor)
*[[Yersinia enterocolitica]] (inflammatory mass, lymphoid mass, or Intususception of intestine)

==Complete Differential Diagnosis of Causes of Abdominal Mass (by organ system)==
{|style="width:90%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | *[[Abdominal Aortic Aneurysm]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
[[Acute pancreatitis]], [[Ascites]], [[Autoimmune pancreatitis]], [[Bezoar]], [[Biliary atresia]], [[Blind loop syndrome]], [[Bowel obstruction]], [[Cholangiocarcinoma]], [[Cholecystitis]], [[Choledochal cyst]], [[Cholelithiasis]], [[Cirrhosis]], [[Colonic diverticulitis]], Congenital hypertrophic pyloric stenosis, [[Congenital megacolon]], [[Constipation]], [[Crohn's disease]], [[Distal intestinal obstruction syndrome]], [[Gastroschisis]], [[Hepatomegaly]], [[Hirschsprung's disease]], Liver [[granuloma]], Palpable gallbladder (Courvoisier's sign, [[Pancreatic pseudocyst]], [[Pyloric stenosis]], Riedel lobe of liver, [[Splenosis]], [[Toxic megacolon]],
[[Urachal cyst]], [[Vermiform appendix]], [[Volvulus]], [[Wandering spleen]], [[Yersinia enterocolitica]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Acanthocheilonemiasis ]], Alpha-L-iduronidase deficiency (Hurler syndrome), Alpha-L-iduronidase deficiency (Hurler-Scheie syndrome), Alpha-mannosidase deficiency, Apolipoprotein C-II deficiency, Beta [[thalassaemia]] (heterozygous), Chanarin-Dorfman disease, [[Chediak-Higashi disease ]], [[Cholesterol ester storage disease ]], Common variable hypogammaglobulinaemia, Congenital dyserythropoietic anaemia type 1, Congenital erythropoeitic porphyria, [[Coproporphyria, hereditary ]], Cruveilhier-Baumgarten syndrome, Familial alphalipoprotein deficiency, Familial histiocytic reticulosis, Familial hypertriglyceridaemia, Farber lipogranulomatosis, [[Fucosidosis ]], [[Fumarase deficiency ]], Galactose epimerase deficiency,
[[Galactose-1-phosphate uridyltransferase deficiency ], Gangliosidosis GM1 type 1 Gangliosidosis GM1 type 3, Gangliosidosis GM3, [[Gaucher disease ]], Geleophysic dysplasia, Glucose phosphate isomerase deficiency, Glycogenosis type 4
Granulocyte colony stimulating factor, [[Haemochromatosis ]], Haemoglobin C disease
Haemoglobin E disease, Haemoglobin SC disease, [[Haemolytic disease of the newborn]]
[[Hereditary spherocytosis ]], Iduronate-2-sulfatase deficiency, [[Iminodipeptiduria ]]
[[Kartagener syndrome ]], Long chain hydroxyacyl-CoA dehydrogenase deficiency
Macrophage activation syndrome, McLeod phenotype, Mevalonate kinase deficiency
[[Mucopolysaccharidosis VI ]], Neutrophilia, hereditary, Niemann-Pick disease type B
Niemann-Pick Disease, Type C' Norrbottnian Gaucher disease, [[Salla disease ]]
[[Sandhoff disease ]], Sanfilippo disease, [[Sarcoidosis ]], [[Sickle cell disease]]
Zimmermann-Laband syndrome
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[Chediak-Higashi disease ]], Extramedullary haemopoiesis, Familial histiocytic reticulosis, Fanconi-Bickel syndrome, [[Haemochromatosis ]], [[Sickle cell crisis ]], Haemoglobin C disease, Haemoglobin E disease, Haemoglobin SC disease, [[Haemolytic disease of the newborn]], [[Hereditary spherocytosis ]], [[Mastocytosis ]], [[Myelofibrosis ]], Hereditary neutrophilia, [[Vitamin B12 deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Abscess]], [[Actinomyces]], [[Alveolar hydatid disease]], [[Bartonellosis]], [[Brucellosis]], [[Cat scratch fever]], [[Entamoeba histolytica]], [[Gallbladder empyema]], [[kala-azar]], [[Leishmaniasis]], [[Kaposi sarcoma]], [[Liver abscess]], Liver [[granuloma]], [[Lymphogranuloma venereum]], [[Malaria]], [[Mycobacterium tuberculosis]], [[Oesophagostomiasis]], Pancreatic [[abscess]], [[Pelvic inflammatory disease]], [[Psittacosis]], [[Relapsing fever ]], [[Syphilis]], congenital, [[Tertiary syphilis]], [[Toxoplasmosis]], congenital, [[Yersinia enterocolitica]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Choriocarcinoma]], [[Ectopic pregnancy]], [[Endometriosis]], [[Meigs syndrome]], [[Pelvic inflammatory disease]], [[Pregnancy]], Uterine enlargement, [[Uterine leiomyoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Adrenal tumor]], [[Brenner tumor]], [[Burkitt's lymphoma]], [[Carcinoid tumours]], [[Cholangiocarcinoma]], [[Choriocarcinoma]], [[Chronic myelogenous leukemia]], [[Colorectal cancer]], [[Desmoplastic small round cell tumor]], [[Endodermal sinus tumor]], Gallbladder benign tumors, [[Gallbladder cancer]], [[Gastrointestinal stromal tumor]], [[Germ cell tumor]], [[Hairy cell leukaemia]], [[Hamartoma]], [[Hemangioendothelioma]], [[Hemangiopericytoma]], [[Hepatic adenoma]], [[Hepatoblastoma]], [[Histiocytosis X]], [[Hodgkin's lymphoma]],
[[Kaposi sarcoma]], [[Kidney cancer]], [[Krukenberg tumor]], [[Leiomyoma]], [[Liposarcoma]], Metastatic Liver cancer, Primary Liver cancer, [[Meigs syndrome]], [[Nephroblastoma]], [[Neurilemmoma]], [[Neuroendocrine tumor]], [[Non-Hodgkin lymphoma]], [[Oncocytoma]], [[Ovarian cancer]], [[Pancreatic cancer]], [[Pancreatic islet cell tumors]], [[Phaeochromocytoma]], [[Plexosarcoma]], [[POEMS syndrome]], [[Pseudomyxoma peritonei]], [[Renal cell carcinoma]], [[Renal oncocytoma]], [[Rhabdoid tumor]], [[Sacrococcygeal teratoma]], [[Sickle cell crisis]], [[Sister Mary Joseph nodule]], Small bowel [[lymphoma]], Spleen [[lymphoma]], [[Stomach cancer]], [[Transitional cell carcinoma]], [[Uterine leiomyoma]], Wilm's tumor
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| Bladder distention, [[Cryptorchidism]], [[Hydronephrosis]], [[Kidney cancer]], [[Pelvic kidney]], [[Polycystic kidney disease]], [[Renal cell carcinoma]], [[Renal oncocytoma]], [[Renal transplantation]], [[Transitional cell carcinoma]], [[Urine retention]], [[Varicocele]], Wilm's tumor
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Physical Examination===
* Associated symptoms:
*:* [[Rectal bleeding]]
*:* [[Weight change]]
*:* [[Urinary symptoms]]
*:* [[Fever]]
*:* [[Changes in bowel habits]]

====Abdomen====
* Examine [[abdomen]] for areas of [[tenderness]]

====Other====
* Examine [[pelvis]] for areas of [[tenderness]]

===Laboratory Findings===
* [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
* [[Complete blood count]] ([[CBC]])
* [[LFTs]] ([[liver function tests]])
* [[Urinalysis]]
* [[Beta-human chorionic gonadotrophin]]

====Electrolyte and Biomarker Studies====
* [[Electrolytes]]
* [[Tumor markers]] (if concern is [[malignancy]])
* [[Toxicology]] screen
* [[Blood culture]] (if concern is [[infection]])

====X Ray====
* [[KUB]] ([[kidneys, ureters, bladder]]) [[x-rays]] could possibly reveal free [[intraperitoneal]] air, [[constipation]] or obstruction.

====MRI and CT====
* Abdominal [[CT]] with oral [[IV]] contrast will evaluate for bowel [[pathology]], [[abscess]], and [[hepatosplenomegaly]]

====Other Diagnostic Studies====
* [[Laparoscopy]] of the intra-abdominal cavity allows for direct visualization
* [[Colonoscopy]] helps in the diagnosis of bowel [[pathology]]
* [[Paracentesis]] with fluid evaluation.

==Treatment==
* Immediately treat life-threatening causes (such as abdominal aortic aneurysms).
* Organomegaly typically resolves once the underlying etiology is treated.

===Acute Pharmacotherapies===
* [[Ogilvie's syndrome]] responds to decompression by IV [[neostigmine]] or by a rectal tube
* [[Constipation]] is usually treated with [[laxative]]s, increased dietary fiber and fluids, enemas.
*:* Manual disimpaction is reserved for fecal impaction.
*:* Stop use of offending medications.
* Masses caused by infections require [[antibiotic]]s (and possible surgery)

===Surgery and Device Based Therapy===
* Several benign and malignant masses require surgical intervention
* [[Hirschsprung's disease]] often requires surgery.

==References==
{{Reflist|2}}

==Additional Resources==
* [http://www.nlm.nih.gov/medlineplus/ency MedlinePlus medical encyclopedia]: [http://www.nlm.nih.gov/medlineplus/ency/article/003274.htm Abdominal mass] - An informative primer on abdominal masses and their common causes.
* [http://gastroresource.com/GITextbook/en/Default.htm First Principles of Gastroenterology]: [http://gastroresource.com/GITextbook/En/chapter1/1-18.htm Abdominal Mass] - This chapter discusses the basic approach to abdominal masses.

==Acknowledgements==
The content on this page was first contributed by {{CMG}}

{{SIB}}

[[Category:Signs and symptoms]]
[[Category:Oncology]]
[[Category:Gastroenterology]]
[[Category:Hematology]]
[[Category:Gynecology]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Completed signs and symptoms

2009-06-20T18:45:12Z

Johnfanisrour:

[[Abdominal angina]] MUT

[[Abdominal bruit]] Jacob Keane-Candib(JKC)

[[Abdominal distension]] MUT

[[Abdominal guarding]]

[[Abdominal mass]] john fani srour (JFS)

[[Abdominal pain]] MUT

[[Accommodative insufficiency]] (BMB))

[[Acute bronchitis]] MUT

[[Amenorrhea]] MUT

[[Anasarca]] (JFS)

[[Anhedonia]] MUT

[[Anorexia (symptom)]]

[[Aphasia]]

[[Arthralgia]] JFS

[[Ascites]] MUT

[[Aura (symptom)]]

[[Azotemia]] MUT

[[Bradycardia]] MUT

[[Back pain]] MUT

[[Beau's lines]] CMG

[[Blurred vision]] MK

[[Chronic pain]] MUT

[[Colitis]] MK

[[Cough]] MUT

[[Constipation]] MUT

[[Diarrhea]] MUT

[[Dry mouth]] MUT

[[Fatigue]] MUT

[[Fever]] MUT

[[Headache]] CMG

[[Hematemesis]] JFS

[[Joint pain]] JFS

[[Muehrcke's lines]] CMG

[[Muscle weakness]] MUT

[[Nausea]] & [[Vomiting]] MUT

[[Pedal edema]] MUT

[[Polydipsia]] JFS

[[Psoriatic Arthritis]] DRO

[[Respiratory failure]] MUT

[[Sore throat]] MUT

[[Sudden death]] MUT

[[Synovitis]] MUT

[[Tachycardia]] MUT

[[Tenosynovitis]] MUT

[[Vasculitis]] MUT

[[Weight loss]] MUT

[[Clubbing]] JFS

[[Genital ulcer]] JFS

[[Exophthalmos]] JFS

[[Trousseau sign of malignancy]] JFS

2009-06-10T18:40:27Z

Johnfanisrour:

File:Wikidocsearchresults 983.xls

2009-06-03T18:04:54Z

Johnfanisrour: uploaded a new version of "Image:Wikidocsearchresults 983.xls"

Importing image file

Trousseau sign of malignancy

2009-06-03T18:02:39Z

Johnfanisrour:

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = |
ICD9 = |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = |
}}
{{Search infobox}}
{{CMG}}

{{JFS}}

{{Editor Help}}

The '''Trousseau sign of malignancy''' is a [[medical sign]] commonly found in certain [[cancer]]s. It is also referred to as '''Trousseau syndrome''' and is distinct from the [[Trousseau sign of latent tetany]].

Some malignancies, especially [[adenocarcinoma]]s of the [[pancreas]] and [[lung]], are associated with hypercoagulability (the tendency to form blood clots) for reasons that are incompletely understood, but may be related to factors secreted by the tumors. In patients with malignancy-associated hypercoagulable states, the blood may spontaneously form clots in the portal vessels, the deep veins of the extremities (such as the leg), or the superficial veins anywhere on the body. These clots present as visibly swollen blood vessels ([[vasculitis]]), especially the veins, or as intermittent pain in the affected areas. The pathological phenomenon of clots forming, resolving and then appearing again elsewhere in the body has been named '''thrombophlebitis migrans''' or '''migratory thrombophlebitis'''.

[[Armand Trousseau]] first described this finding in himself; he was subsequently diagnosed with [[pancreatic cancer]].

===Complete Differential Diagnosis of the Causes of Trousseau Sign of Malignancy===
(In alphabetical order)

Migratory thrombophlebitis:

* [[Colon cancer]]
* [[Gastric carcinoma]]<ref name="pmid5368868">{{cite journal |author=Morgun IF |title=[Migrating thrombophlebitis in gastric cancer] |language=Russian |journal=Vrach Delo |volume=5 |issue= |pages=135–7 |year=1969 |month=May |pmid=5368868 |doi= |url=}}</ref>
* [[Lung cancer]]
* [[Ovarian cancer]]<ref name="pmid10612175">{{cite journal |author=Kukhtevich AV, Russkikh AV, Kuznetsova AI, Gorbacheva EN |title=[Paraneoplastic syndrome (fever, anemia, migrating thrombophlebitis) in ovarian cancer] |language=Russian |journal=Ter. Arkh. |volume=71 |issue=10 |pages=46–8 |year=1999 |pmid=10612175 |doi= |url=}}</ref>
* [[Pancreatic cancer]]

===Complete Differential Diagnosis of the Causes of Trousseau Sign of Malignancy:===
(By organ system)
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Colon cancer]], [[Gastric carcinoma]], [[Pancreatic cancer]]

|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Ovarian cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Colon cancer]], [[Gastric carcinoma]], [[Lung cancer]], [[Pancreatic cancer]], [[Ovarian cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Lung cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==See also==
* [[Armand Trousseau]]

{{Symptoms and signs}}
{{SIB}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

[[Category:Medical signs]]
[[Category:Signs and symptoms]]

Completed signs and symptoms

2009-06-03T17:58:30Z

Johnfanisrour:

[[Abdominal bruit]] Jacob Keane-Candib(JKC)

[[Abdominal guarding]]

[[Abdominal mass]] john fani srour (JFS)

[[Abdominal pain]] MUT

[[Accommodative insufficiency]] (BMB))

[[Anasarca]] (JFS)

[[Anorexia (symptom)]]

[[Aphasia]]

[[Arthralgia]] JFS

[[Aura (symptom)]]

[[Bradycardia]] MUT

[[Back pain]] MUT

[[Beau's lines]] CMG

[[Cough]] MUT

[[Constipation]] MUT

[[Diarrhea]] MUT

[[Fatigue]] MUT

[[Fever]] MUT

[[Headache]] CMG

[[Hematemesis]] JFS

[[Joint pain]] JFS

[[Muehrcke's lines]] CMG

[[Nausea]] & [[Vomiting]] MUT

[[Pedal edema]] MUT

[[Polydipsia]] JFS

[[Psoriatic Arthritis]] DRO

[[Respiratory failure]] MUT

[[Sore throat]] MUT

[[Sudden death]] MUT

[[Tachycardia]] MUT

[[Vasculitis]] MUT

[[Clubbing]] JFS

[[Genital ulcer]] JFS

[[Trousseau sign of malignancy]] JFS

Trousseau sign of malignancy

2009-06-03T17:56:00Z

Johnfanisrour:

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = |
ICD9 = |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = |
}}
{{Search infobox}}
{{CMG}}

{{JFS}}

{{Editor Help}}

The '''Trousseau sign of malignancy''' is a [[medical sign]] commonly found in certain [[cancer]]s. It is also referred to as '''Trousseau syndrome''' and is distinct from the [[Trousseau sign of latent tetany]].

Some malignancies, especially [[adenocarcinoma]]s of the [[pancreas]] and [[lung]], are associated with hypercoagulability (the tendency to form blood clots) for reasons that are incompletely understood, but may be related to factors secreted by the tumors. In patients with malignancy-associated hypercoagulable states, the blood may spontaneously form clots in the portal vessels, the deep veins of the extremities (such as the leg), or the superficial veins anywhere on the body. These clots present as visibly swollen blood vessels ([[vasculitis]]), especially the veins, or as intermittent pain in the affected areas. The pathological phenomenon of clots forming, resolving and then appearing again elsewhere in the body has been named '''thrombophlebitis migrans''' or '''migratory thrombophlebitis'''.

[[Armand Trousseau]] first described this finding in himself; he was subsequently diagnosed with [[pancreatic cancer]].

===Complete Differential Diagnosis of the Causes of Trousseau Sign of Malignancy===
(In alphabetical order)

Migratory thrombophlebitis:

* [[Colon cancer]]
* [[Gastric carcinoma]]<ref name="pmid5368868">{{cite journal |author=Morgun IF |title=[Migrating thrombophlebitis in gastric cancer] |language=Russian |journal=Vrach Delo |volume=5 |issue= |pages=135–7 |year=1969 |month=May |pmid=5368868 |doi= |url=}}</ref>
* [[Lung cancer]]
* [[Ovarian cancer]]<ref name="pmid10612175">{{cite journal |author=Kukhtevich AV, Russkikh AV, Kuznetsova AI, Gorbacheva EN |title=[Paraneoplastic syndrome (fever, anemia, migrating thrombophlebitis) in ovarian cancer] |language=Russian |journal=Ter. Arkh. |volume=71 |issue=10 |pages=46–8 |year=1999 |pmid=10612175 |doi= |url=}}</ref>
* [[Pancreatic cancer]]

===Complete Differential Diagnosis of the Causes of Trousseau Sign of Malignancy:===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Colon cancer]], [[Gastric carcinoma]], [[Pancreatic cancer]]

|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Ovarian cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Colon cancer]], [[Gastric carcinoma]], [[Lung cancer]], [[Pancreatic cancer]], [[Ovarian cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Lung cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==See also==
* [[Armand Trousseau]]

{{Symptoms and signs}}
{{SIB}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

[[Category:Medical signs]]
[[Category:Signs and symptoms]]

Johnfanisrour:

{{Infobox_Disease |
Name = Clubbing |
Image = ClubbingFingers1.jpg |
Caption = Clubbing in the fingers of a 33-year old female with [[pulmonary hypertension]]. |
ICD10 = R68.3 |
ICD9 = {{ICD9|781.5}} |
}}
{{SI}}
{{CMG}}

{{Editor Help}}

== Overview ==
In [[medicine]], '''clubbing''', ''finger clubbing'', or ''digital clubbing'' is a deformity of the [[finger]]s and [[Nail (anatomy)|fingernail]]s that is associated with a number of diseases, mostly of the [[heart disease|heart]] and [[lung disease|lungs]]. [[Idiopathic]] clubbing can also occur. [[Hippocrates]] was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called '''Hippocratic fingers'''.

==Epidemiology==
The exact frequency of clubbing in the population is not known. A 2008 study found clubbing in 1% of all patients admitted to a department of [[internal medicine]]. Of these, 40% turned out to have significant underlying disease of various causes, while 60% had no medical problems on further investigations and remained well over the subsequent year.<ref>{{cite journal |author=Vandemergel X, Renneboog B |title=Prevalence, aetiologies and significance of clubbing in a department of general internal medicine |journal=Eur. J. Intern. Med. |volume=19 |issue=5 |pages=325–9 |year=2008 |month=July |pmid=18549933 |doi=10.1016/j.ejim.2007.05.015}}</ref>

==Pathophysiology==

The exact cause for sporadic clubbing is unknown, and there are numerous theories as to its cause. [[Vasodilation]] (distended blood vessels), secretion of [[growth factor]]s (such as [[platelet-derived growth factor]] and [[hepatocyte growth factor]]) from the lungs, and other mechanisms have been proposed. The discovery of disorders in the [[prostaglandin]] metabolism in primary osteo-arthropathy has led to suggestions that overproduction of PGE2 by other tissues may be the causative factor for clubbing.<ref>Uppal S, Diggle CP, Carr IM, et al (June 2008). "Mutations in 15-hydroxyprostaglandin dehydrogenase cause primary hypertrophic osteoarthropathy". Nat. Genet. 40 (6): 789–93. doi:10.1038/ng.153. PMID 18500342</ref>

==Diagnosis==
==Signs and symptoms==

Clubbing develops in five steps:<ref name=Myers>{{cite journal | author=Myers KA, Farquhar DR | title=The rational clinical examination: does this patient have clubbing? | journal=JAMA | year=2001 | volume=286 | pages=341–7 | pmid=11466101 | url= | doi=10.1001/jama.286.3.341}}</ref>
# Fluctuation and softening of the nail bed (increased ballotability)
# Loss of the normal <165° angle ("''Lovibond angle''") between the nailbed and the fold (''cuticula'')
# Increased convexity of the nail fold
# Thickening of the whole [[distal]] (end part of the) finger (resembling a drumstick)
# Shiny aspect and [[striation]] of the nail and skin

''Schamroth's test'' or ''Schamroth's window test'' (originally demonstrated by South African cardiologist Dr Leo Schamroth on himself<ref>{{cite journal |author=Schamroth L |title=Personal experience |journal=S. Afr. Med. J. |volume=50 |issue=9 |pages=297–300 |year=1976 |month=February |pmid=1265563}}</ref>) is a popular test for clubbing. When the distal [[phalanges]] (bones nearest the fingertips) of corresponding fingers of opposite hands are directly [[wikt:appose|apposed]] (placed against each other back to back), a small diamond-shaped "window" is normally apparent between the nailbeds. If this window is obliterated, the test is positive and clubbing is present.

When clubbing is encountered in patients, doctors will seek to identify its cause. They usually accomplish this by obtaining a [[anamnesis|medical history]]— particular attention is paid to lung, heart, and gastrointestinal conditions —and conducting a [[clinical examination]], which may disclose associated features relevant to a diagnosis. Additional studies such as a chest x-ray may also be performed.

<gallery>
Image:Clubbing.png|Clubbing of the fingernail. The red line shows the outline of a clubbed nail.
</gallery>

===Physical Examination===
==== Extremities ====
[[Image:clubbing.jpg|thumb|left|Clubbing<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]]
 

==Disease associations==
Although many diseases are associated with clubbing (particularly lung diseases), the reports are fairly anecdotal. Prospective studies of patients presenting with clubbing have not yet been performed, and hence there is no conclusive evidence of these associations.

===Isolated clubbing===

Clubbing is associated with:
* Lung disease:
** [[Lung cancer]], mainly large-cell (35% of all cases), not seen frequently in small cell lung cancer<ref>Sridhar KS, Lobo CF, Altman RD. Digital clubbing and lung cancer. ''Chest'' 1998;114:1535-37. PMID 9872183</ref>
** [[Interstitial lung disease]]
** [[Tuberculosis]]
** [[Bronchiectasis]]
** Suppurative lung disease: [[lung abscess]], [[empyema]]
** [[Cystic fibrosis]]
** [[Pulmonary hypertension]]
** [[Mesothelioma]]
** It is worth noting that clubbing is ''not'' associated with [[chronic obstructive pulmonary disease]] (COPD). Indeed, the presence of clubbing in a patient with COPD should prompt a search for an underlying (lung) cancer.
* Heart disease:
** Any disease featuring chronic [[hypoxia (medical)|hypoxia]]
** Congenital cyanotic heart disease (most common cardiac cause)
** [[Endocarditis|Subacute bacterial endocarditis]]
** [[Atrial myxoma]] (benign tumor)
* Gastrointestinal and hepatobiliary:
** [[Malabsorption]]
** [[Crohn's disease]] and [[ulcerative colitis]]
** [[Cirrhosis]], especially in [[primary biliary cirrhosis]]<ref>{{cite journal |author=Epstein O, Dick R, Sherlock S |title=Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease |journal=Gut |volume=22 |issue=3 |pages=203-6 |year=1981 |pmid=7227854}}</ref>
** Other [[liver]] diseases (in the "hepatopulmonary syndrome", a complication of [[cirrhosis]])<ref>Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. ''Swiss Med Wkly.'' 2003;133:163-9. PMID 12715285.</ref>

* Others:
** [[Hyperthyroidism]] (''thyroid acropachy'')<ref>{{GPnotebook|-724565997}}</ref>
** Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing)
** Vascular anomalies of the affected arm such as an [[axillary artery]] [[aneurysm]] (in unilateral clubbing)

===Clubbing associated with other symptoms===
===HPOA===
{{main|Periosteal reaction}}
[[Image:Marie-Bamberger2.jpg|thumb|right|[[Bone scan]] of a patient with ''Marie-Bamberger syndrome'']]
A special form of clubbing is '''hypertrophic pulmonary osteo-arthropathy''', known in continental Europe as ''Pierre Marie-Bamberger syndrome''. (In dogs the condition is known as [[hypertrophic osteopathy]].) This is the combination of clubbing and thickening of [[periosteum]] (connective tissue lining of the bones) and [[synovium]] (lining of joints), and is often initially diagnosed as [[arthritis]]. It is commonly associated with lung cancer.

===Primary HOA===
Primary hypertrophic osteo-arthropathy is HPOA without signs of pulmonary disease. This form has a hereditary component, although subtle cardiac abnormalties can occasionally be found. It is known in continental Europe as the ''Touraine-Solente-Golé syndrome''. This condition has been linked to mutations in the gene on the fourth chromosome (4q33-q34)coding for the enzyme [[15-hydroxyprostaglandin dehydrogenase]] (HPGD); this leads to decreased breakdown of [[PGE2|prostaglandin E2]] and elevated levels of this substance.<ref name=Uppal>{{cite journal |author=Uppal S, Diggle CP, Carr IM, ''et al'' |title=Mutations in 15-hydroxyprostaglandin dehydrogenase cause primary hypertrophic osteoarthropathy |journal=Nat. Genet. |volume=40 |issue=6 |pages=789–93 |year=2008 |month=June |pmid=18500342 |doi=10.1038/ng.153}}</ref>

===Secondary HOA===

It is usually associated with lung cancer, pulmonary infections, cystic fibrosis, right-to-left cardiac shunts, and less often in Hodgkin lymphoma and cirrhosis. Among patients with lung cancer, HOA is most frequently associated with adenocarcinoma and least frequently with small cell carcinoma <ref name="pmid9872183">{{cite journal |author=Sridhar KS, Lobo CF, Altman RD |title=Digital clubbing and lung cancer |journal=Chest |volume=114 |issue=6 |pages=1535–7 |year=1998 |month=December |pmid=9872183 |doi= |url=}}</ref> Rarely, arterial vascular prosthesis infections may be associated with HOA<ref name="pmid16721260">{{cite journal |author=Alonso-Bartolomé P, Martínez-Taboada VM, Pina T, Blanco R, Rodriguez-Valverde V |title=Hypertrophic osteoarthropathy secondary to vascular prosthesis infection: report of 3 cases and review of the literature |journal=Medicine (Baltimore) |volume=85 |issue=3 |pages=183–91 |year=2006 |month=May |pmid=16721260 |doi=10.1097/01.md.0000224714.27508.8b |url=}}</ref>. Clinical features suggestive of vascular infection-related HOA include clubbing or periosteal new bone formation in a single limb.

==See also==
* [[Periosteal reaction]] for more on HPOA and primary HOA
* [[clubbed thumb]]

===Complete Differential Diagnosis of the Causes of Clubbing===
(In alphabetical order)
* [[achalasia]]
* [[Arteriovenous malformation]]s
* Arterial vascular [[prosthesis]] infections
* [[Atrial myxoma]]
* Bronchial carcinomas
* [[Bronchiectasis]]
* [[Cannabis]] <ref name="pmid18238953">{{cite journal |author=Schuller A, Cottin V, Hot A, Cordier JF |title=Finger clubbing and altered carbon monoxide transfer capacity in cannabis smokers |journal=Eur. Respir. J. |volume=31 |issue=2 |pages=473–4 |year=2008 |month=February |pmid=18238953 |doi=10.1183/09031936.00150907 |url=}}</ref>
* [[Celiac Sprue]]
* [[Cerebrovascular insult]]
* Chronic obstructive [[jaundice]]
* [[Cirrhosis]]
* Cyanotic [[congenital heart disease]]<ref name="pmid3909407">{{cite journal |author=Pineda CJ, Guerra J, Weisman MH, Resnick D, Martinez-Lavin M |title=The skeletal manifestations of clubbing: a study in patients with cyanotic congenital heart disease and hypertrophic osteoarthropathy |journal=Semin. Arthritis Rheum. |volume=14 |issue=4 |pages=263–73 |year=1985 |month=May |pmid=3909407 |doi= |url=}}</ref>
**[[Tetralogy of Fallot]]
**[[Total anomalous venous return]]
**[[Transposition of the great vessels]]
**[[Tricuspid atresia]]
**[[Truncus arteriosus]]
* [[Cystic Fibrosis]]
* [[Emphysema]]
* [[Empyema]]
* [[Endocarditis]]
* [[Heart failure]]
* [[Hepatoma]]
* [[Hodgkin's lymphoma]]<ref name="pmid5553121">{{cite journal |author=Mullins GM, Lenhard RE |title=Digital clubbing in Hodgkin's disease |journal=Johns Hopkins Med J |volume=128 |issue=3 |pages=153–7 |year=1971 |month=March |pmid=5553121 |doi= |url=}}</ref>
* [[Interstitial lung disease]]
* [[Liver tumor]]s
* [[Lung abscess]]
* [[metastatic melanoma]]<ref name="pmid16314744">{{cite journal |author=Thompson MA, Warner NB, Hwu WJ |title=Hypertrophic osteoarthropathy associated with metastatic melanoma |journal=Melanoma Res. |volume=15 |issue=6 |pages=559–61 |year=2005 |month=December |pmid=16314744 |doi= |url=}}</ref>
* [[Mesothelioma]]
* [[Pachydermoperiostosis]]
*[[POEMS]] [polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes]: a rare paraneoplastic syndrome secondary to a plasma cell dyscrasia in which clubbing may be seen. Other findings including peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma proliferative disorder, skin changes, sclerotic bone lesions, Castleman disease, thrombocytosis, papilledema, peripheral edema, pleural effusions, ascites, and white nails.
* [[Primary biliray cirrhosis]]
* [[Pulmonic stenosis]]
* Pulmonary artery [[sarcoma]]<ref name="pmid8769527">{{cite journal |author=Loredo JS, Fedullo PF, Piovella F, Moser KM |title=Digital clubbing associated with pulmonary artery sarcoma |journal=Chest |volume=109 |issue=6 |pages=1651–3 |year=1996 |month=June |pmid=8769527 |doi= |url=}}</ref>
* [[Pulmonary fibrosis]]
* Pulmonary metastases
* Right-to-left [[cardiac shunt]]s
* [[sarcoidosis]] of the lungs <ref name="pmid">{{cite journal |author=West SG, Gilbreath RE, Lawless OJ |title=Painful clubbing and sarcoidosis |journal=JAMA |volume=246 |issue=12 |pages=1338–9 |year=1981 |month=September |pmid= |doi= |url=}}</ref>
* [[Silicosis]]
* [[Thyroid cancer]]
* [[Thyrotoxicosis]]
* [[Tuberculosis]]
* [[Ulcerative colitis]]

===Complete Differential Diagnosis of the Causes of Clubbing===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Cyanotic congenital heart disease, right-to-left [[shunting]], [[bacterial [[endocarditis]], [[Tetralogy of Fallot]], [[Total anomalous venous return]], [[Transposition of the great vessels]], [[Tricuspid atresia]], [[Truncus arteriosus]], [[arteriovenous malformation]]s , arterial vascular [[prosthesis]] infections, [[Atrial myxoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Cannabis]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Cannabis]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[ulcerative colitis]], [[Crohn disease]], [[primary biliary cirrhosis]], [[cirrhosis]] of the liver, [[leiomyoma]] of the esophagus, [[achalasia]], and [[peptic ulcer]] of the esophagus, [[Celiac Sprue]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Cannabis]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Thyroid cancer]], [[thymus cancer]], [[Hodgkin's disease]], [[POEMS]], [[metastatic melanoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[lung cancer]], [[cystic fibrosis]], [[interstitial lung disease]], [[idiopathic pulmonary fibrosis]], [[ sarcoidosis]],[[lipoid pneumonia]], [[empyema]], [[pleural mesothelioma]], pulmonary artery [[sarcoma]], [[cryptogenic fibrosing alveolitis]], pulmonary metastases, [[Bronchiectasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==References==
{{reflist|2}}

{{Symptoms and signs}}
{{SIB}}

[[de:Trommelschlägelfinger]]
[[es:Acropaquia]]
[[fr:Hypocratisme digital]]
[[it:Dita_ippocratiche]]
[[ja:ばち指]]
[[no:Trommestikkfingre]]
[[pt:Hipocratismo digital]]

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[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Cardiology]]
[[Category:Pulmonology]]
[[Category:Physical examination]]

[[pl:Palce pałeczkowate]]

Clubbing

2009-05-26T19:11:09Z

Johnfanisrour:

Clubbing

2009-05-26T18:56:28Z

Johnfanisrour:

2009-04-15T19:12:09Z

Johnfanisrour:

Arthralgia

2009-04-15T19:08:15Z

Johnfanisrour:

{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 15237
| ICD10 = {{ICD10|M|25|5|m|20}}
| ICD9 = {{ICD9|719.4}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D018771
}}
{{SI}}
{{CMG}}

{{JFS}}

{{EH}}
==Overview==
'''Arthralgia''' (from Greek ''arthro-'', joint + ''-algos'', pain) literally means ''joint pain''; <ref name="medterms_arthralgia">
{{cite web
|url=http://www.medterms.com/script/main/art.asp?articlekey=2343
|title= Arthralgia Definition
|accessdate=2007-09-20
|format= HTML
|work=MedicineNet.com }}</ref><ref name="jgh_arthralgia"> {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Arthralgia
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref> it is a symptom of injury, infection, illnesses
-- in particular [[arthritis]]-- or an allergic reaction to medication.<ref name="drugReaction" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Allergic Drug Reactions - Systemic Allergic Drug Reactions
|author=James R Philp
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

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.<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?field=uid&term=D018771 |title=MeSH |accessdate=2007-12-23 |format= |work=}}</ref>

==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 <ref name="jgh_arthralgia"/>. 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.<ref name="jgh_arthralgia"/> <ref name="spondyl_table1" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Table 159.3. Selected Symptomatic Extraarticular Features of the Connective Tissue Diseases and the Spondyloarthropathies
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>
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 [[Arthritic|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). <ref name="nihbook_2">{{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Table 161.1. Some Common Regional Rheumatic Syndromes
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

==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]]
*[[Atypical pneumonia]]
*[[Behcet's disease]]
*[[Bismuth]]
*[[Blau syndrome]] (granulomatous [[arthritis]], [[iritis]], and [[skin rash]])
*[[Borrelia burgdorferi]] ([[Lyme Disease]])
*[[Bruton's agammaglobulinemia]]
*[[Caplan's disease]] ([[rheumatoid arthritis]] and [[pneumoconiosis]])
*[[Carbimazole]]
*[[Chikungunya virus]]
*[[Chikungunya]]
*[[Chronic fatigue syndrome]]
*[[Ciprofloxacin]] ([[Quinolone]]-induced cartilage toxicity in children)
*[[Coccidioidomycosis]] lung infection
*[[Coeliac disease]]
*[[Community-acquired pneumonia]]
*[[Crohn's disease]]
*[[Cryoglobulinaemia]]
*[[Decompression sickness]]
*[[Deferiprone]]
*Diffuse idiopathic skeletal [[hyperostosis]]
*[[Dressler's syndrome]]
*[[Ehlers-Danlos syndrome]]
*[[Erythema elevatum diutinum]] (is a rare type of [[leukocytoclastic vasculitis]] characterized by red, purple, brown, or yellow [[papule]]s, [[plaque]]s, or [[nodule]]s)
*[[Farber's disease]]
*[[Fibromyalgia]]
*[[Fluorosis]]
*[[Fracture]] of bone
*[[Gout]]
*[[Graft versus host disease]]
*[[Haemochromatosis]]
*[[Haemophilia type A]]
*[[Henoch-Schönlein purpura]]
*[[Hepatitis]] [[Hepatitis A|A]], [[Hepatitis B|B]], [[Hepatitis C|C]]
*[[Hip dysplasia]], congenital
*[[Hyperimmunoglobulinemia D]] and [[periodic fever syndrome]] ( attacks of [[fever]], arthralgia, [[skin lesion]]s, and [[diarrhea]])
*[[Hypertrophic pulmonary osteoarthropathy]]
*[[Hypothyroidism]]
*[[Interstitial nephritis]]
*[[Isotretinoin]]
*Jacobs arthropathy-camptodactyly syndrome
*[[Juvenile chronic arthritis]]
*[[Kawasaki disease]]
*[[Lepromatous leprosy]]
*Lipoid dermatoarthritis
*[[Lupus erythematosus]]
*[[Lyme disease]]
*[[Malaria]]
*Mayaro virus 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]]
*[[Mycoplasma pneumoniae]]
*[[Nalidixic acid]]
*[[Nateglinide]]
*[[Norfloxacin]]
*[[Obesity]]
*O'nyong-nyong fever
*[[Osteoarthritis]]
*[[Osteochondritis]] dissecans
*[[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)
*[[Polyarteritis nodosa]]
*[[Polychondritis]], Relapsing
*Progressive pseudorheumatoid dysplasia
*[[Propylthiouracil]]
*[[Pyoderma gangrenosum]]
*[[Pyrazinamide]]
*[[Pyrophosphate arthropathy]] ([[Pseudogout]])
*[[Rat bite fever]] (Streptobacillus moniliformis or Spirillum minus)
*Recurrent hereditary polyserositis
*[[Rheumatic Fever]]
*[[Rheumatoid arthritis]]
*[[Ross River virus]]
*[[Rubella]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*Sclerosing [[osteomyelitis]] of Garre
*Secondary [[syphilis]]
*Semliki forest fever
*[[Serum sickness]]
*[[Sickle cell disease]]
*[[Sjögren's syndrome]]
*[[Stickler syndrome]]
*[[Still's Disease]], Juvenile-Onset
*[[Sweet's disease]]
*[[Synovial chondromatosis]]
*[[Systemic sclerosis]]
*[[Takayasu's arteritis]]
*[[Takayasu's arteritis]]
*[[Toxic shock syndrome]]
*[[Trastuzumab]]
*[[Trichinosis]]
*[[Ulcerative Colitis]]
*Urate crystal arthropathy ([[gout]])
*[[Waldenström macroglobulinemia]]
*[[Wegener's granulomatosis]]
*[[West Nile fever]]
*[[Whipple disease]]
*[[Wilson's disease]]
*Wissler-Fanconi syndrome
*[[Zotepine]]

===Complete Differential Diagnosis of the Causes of Arthralgia===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Dressler's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Bismuth]], [[Carbimazole]], [[Ciprofloxacin]], [[Deferiprone]], [[Fluorosis]], [[Isotretinoin]], [[Methimazole]], [[Mianserin]], [[mirtazapine]], [[nefazodone]], [[Nalidixic acid]], [[Nateglinide]], [[Norfloxacin]], [[Propylthiouracil]], [[Pyrazinamide]], [[Trastuzumab]], [[Zotepine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Coeliac disease]], [[Crohn's disease]], [[Hepatitis]] A, B, C, [[Ulcerative Colitis]], [[Whipple disease]], [[Wilson's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Haemochromatosis]], [[Haemophilia type A]], [[Henoch-Schönlein purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Multiple myeloma]], [[Pigmented villonodular synovitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Atypical pneumonia]], [[Caplan's disease]], [[Coccidioidomycosis]] lung infection, [[Community-acquired pneumonia]], [[Mycoplasma pneumoniae]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|"|[[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

==See also==
==References==
{{reflist|2}}

==External links==

{{Diseases of the musculoskeletal system and connective tissue}}
{{SIB}}

[[de:Arthralgie]]
[[fr:Arthralgie]]

[[Category:Rheumatology]]
[[Category:Signs and symptoms]]

[[pl:Artralgia]]

{{WH}}
{{WS}}

Arthralgia

2009-04-15T18:49:21Z

Johnfanisrour:

{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 15237
| ICD10 = {{ICD10|M|25|5|m|20}}
| ICD9 = {{ICD9|719.4}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D018771
}}
{{SI}}
{{CMG}}

{{JFS}}

{{EH}}
==Overview==
'''Arthralgia''' (from Greek ''arthro-'', joint + ''-algos'', pain) literally means ''joint pain''; <ref name="medterms_arthralgia">
{{cite web
|url=http://www.medterms.com/script/main/art.asp?articlekey=2343
|title= Arthralgia Definition
|accessdate=2007-09-20
|format= HTML
|work=MedicineNet.com }}</ref><ref name="jgh_arthralgia"> {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Arthralgia
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref> it is a symptom of injury, infection, illnesses
-- in particular [[arthritis]]-- or an allergic reaction to medication.<ref name="drugReaction" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Allergic Drug Reactions - Systemic Allergic Drug Reactions
|author=James R Philp
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

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.<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?field=uid&term=D018771 |title=MeSH |accessdate=2007-12-23 |format= |work=}}</ref>

==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 <ref name="jgh_arthralgia"/>. 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.<ref name="jgh_arthralgia"/> <ref name="spondyl_table1" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Table 159.3. Selected Symptomatic Extraarticular Features of the Connective Tissue Diseases and the Spondyloarthropathies
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>
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 [[Arthritic|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). <ref name="nihbook_2">{{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Table 161.1. Some Common Regional Rheumatic Syndromes
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

==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]]
*[[Atypical pneumonia]]
*[[Behcet's disease]]
*[[Bismuth]]
*[[Blau syndrome]] (granulomatous [[arthritis]], [[iritis]], and [[skin rash]])
*[[Borrelia burgdorferi]] ([[Lyme Disease]])
*[[Bruton's agammaglobulinemia]]
*[[Caplan's disease]] ([[rheumatoid arthritis]] and [[pneumoconiosis]])
*[[Carbimazole]]
*[[Chikungunya virus]]
*[[Chikungunya]]
*[[Chronic fatigue syndrome]]
*[[Ciprofloxacin]] ([[Quinolone]]-induced cartilage toxicity in children)
*[[Coccidioidomycosis]] lung infection
*[[Coeliac disease]]
*[[Community-acquired pneumonia]]
*[[Crohn's disease]]
*[[Cryoglobulinaemia]]
*[[Decompression sickness]]
*[[Deferiprone]]
*Diffuse idiopathic skeletal hyperostosis
*[[Dressler's syndrome]]
*[[Ehlers-Danlos syndrome]]
*[[Erythema elevatum diutinum]] (is a rare type of [[leukocytoclastic vasculitis]] characterized by red, purple, brown, or yellow [[papule]]s, [[plaque]]s, or [[nodule]]s)
*[[Farber's disease]]
*[[Fibromyalgia]]
*[[Fluorosis]]
*[[Fracture]] of bone
*[[Gout]]
*[[Graft versus host disease]]
*[[Haemochromatosis]]
*[[Haemophilia type A]]
*[[Henoch-Schönlein purpura]]
*[[Hepatitis]] [[Hepatitis A|A]], [[Hepatitis B|B]], [[Hepatitis C|C]]
*[[Hip dysplasia]], congenital
*[[Hyperimmunoglobulinemia D]] and [[periodic fever syndrome]] ( attacks of [[fever]], arthralgia, [[skin lesion]]s, and [[diarrhea]])
*[[Hypertrophic pulmonary osteoarthropathy]]
*[[Hypothyroidism]]
*[[Interstitial nephritis]]
*[[Isotretinoin]]
*Jacobs arthropathy-camptodactyly syndrome
*[[Juvenile chronic arthritis]]
*[[Kawasaki disease]]
*[[Lepromatous leprosy]]
*Lipoid dermatoarthritis
*[[Lupus erythematosus]]
*[[Lyme disease]]
*[[Malaria]]
*Mayaro virus fever
*[[Methimazole]]
*[[Mianserin]] ([[antidepressant]], also [[mirtazapine]] and [[nefazodone]] are associated with arthralgia)
*[[Mixed connective tissue disease]]
*[[Morphoea]]/[[scleroderma]]
*Multiple epiphyseal dysplasia
*[[Multiple myeloma]]
*[[Mycoplasma pneumoniae]]
*[[Nalidixic acid]]
*[[Nateglinide]]
*[[Norfloxacin]]
*[[Obesity]]
*O'nyong-nyong fever
*[[Osteoarthritis]]
*[[Osteochondritis]] dissecans
*[[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)
*[[Polyarteritis nodosa]]
*[[Polychondritis]], Relapsing
*Progressive pseudorheumatoid dysplasia
*[[Propylthiouracil]]
*[[Pyoderma gangrenosum]]
*[[Pyrazinamide]]
*[[Pyrophosphate arthropathy]] ([[Pseudogout]])
*[[Rat bite fever]] (Streptobacillus moniliformis or Spirillum minus)
*Recurrent hereditary polyserositis
*[[Rheumatic Fever]]
*Rheumatoid disease
*[[Ross River virus]]
*[[Rubella]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*Sclerosing osteomyelitis of Garre
*Secondary [[syphilis]]
*Semliki forest fever
*[[Serum sickness]]
*[[Sickle cell disease]]
*[[Sjögren's syndrome]]
*[[Stickler syndrome]]
*[[Still's Disease]], Juvenile-Onset
*[[Sweet's disease]]
*Synovial chondromatosis
*[[Systemic sclerosis]]
*[[Takayasu's arteritis]]
*[[Takayasu's arteritis]]
*[[Toxic shock syndrome]]
*[[Trastuzumab]]
*[[Trichinosis]]
*[[Ulcerative Colitis]]
*Urate crystal arthropathy ([[gout]])
*[[Waldenström macroglobulinemia]]
*[[Wegener's granulomatosis]]
*[[West Nile fever]]
*[[Whipple disease]]
*[[Wilson's disease]]
*Wissler-Fanconi syndrome
*Zotepine

===Complete Differential Diagnosis of the Causes of Arthralgia===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Dressler's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Bismuth]], [[Carbimazole]], [[Ciprofloxacin]], [[Deferiprone]], [[Fluorosis]], [[Isotretinoin]], [[Methimazole]], [[Mianserin]], mirtazapine, nefazodone,
[[Nalidixic acid]], [[Nateglinide]], [[Norfloxacin]], [[Propylthiouracil]], [[Pyrazinamide]]
[[Trastuzumab]], Zotepine
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Coeliac disease]], [[Crohn's disease]], [[Hepatitis]] A, B, C, [[Ulcerative Colitis]], [[Whipple disease]], [[Wilson's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Haemochromatosis]], [[Haemophilia type A]], [[Henoch-Schönlein purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Blau syndrome]], [[Borrelia burgdorferi]], [[Fibromyalgia]], [[Gout]],
[[Hip dysplasia]], congenital, Hypertrophic pulmonary osteo-arthropathy, Jacobs arthropathy-camptodactyly syndrome, Juvenile chronic 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]], Juvenile-Onset, Synovial chondromatosis, [[Systemic sclerosis]], [[Takayasu's arteritis]], [[gout]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Multiple myeloma]], [[Pigmented villonodular synovitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Atypical pneumonia]], [[Caplan's disease]], [[Coccidioidomycosis]] lung infection, [[Community-acquired pneumonia]], [[Mycoplasma pneumoniae]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|"|[[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

==See also==
==References==
{{reflist|2}}

==External links==

{{Diseases of the musculoskeletal system and connective tissue}}
{{SIB}}

[[de:Arthralgie]]
[[fr:Arthralgie]]

[[Category:Rheumatology]]
[[Category:Signs and symptoms]]

[[pl:Artralgia]]

{{WH}}
{{WS}}

Arthralgia

2009-04-15T18:33:05Z

Johnfanisrour:

{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 15237
| ICD10 = {{ICD10|M|25|5|m|20}}
| ICD9 = {{ICD9|719.4}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D018771
}}
{{SI}}
{{CMG}}

{{JFS}}

{{EH}}
==Overview==
'''Arthralgia''' (from Greek ''arthro-'', joint + ''-algos'', pain) literally means ''joint pain''; <ref name="medterms_arthralgia">
{{cite web
|url=http://www.medterms.com/script/main/art.asp?articlekey=2343
|title= Arthralgia Definition
|accessdate=2007-09-20
|format= HTML
|work=MedicineNet.com }}</ref><ref name="jgh_arthralgia"> {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Arthralgia
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref> it is a symptom of injury, infection, illnesses
-- in particular [[arthritis]]-- or an allergic reaction to medication.<ref name="drugReaction" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Allergic Drug Reactions - Systemic Allergic Drug Reactions
|author=James R Philp
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

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.<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?field=uid&term=D018771 |title=MeSH |accessdate=2007-12-23 |format= |work=}}</ref>

==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 <ref name="jgh_arthralgia"/>. 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.<ref name="jgh_arthralgia"/> <ref name="spondyl_table1" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Table 159.3. Selected Symptomatic Extraarticular Features of the Connective Tissue Diseases and the Spondyloarthropathies
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>
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 [[Arthritic|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). <ref name="nihbook_2">{{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Table 161.1. Some Common Regional Rheumatic Syndromes
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

==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]]
*[[Atypical pneumonia]]
*[[Behcet's disease]]
*[[Bismuth]]
*[[Blau syndrome]] (granulomatous [[arthritis]], [[iritis]], and [[skin rash]])
*[[Borrelia burgdorferi]] ([[Lyme Disease]])
*[[Bruton's agammaglobulinemia]]
*[[Caplan's disease]] ([[rheumatoid arthritis]] and [[pneumoconiosis]])
*[[Carbimazole]]
*[[Chikungunya virus]]
*[[Chikungunya]]
*[[Chronic fatigue syndrome]]
*[[Ciprofloxacin]] ([[Quinolone]]-induced cartilage toxicity in children)
*[[Coccidioidomycosis]] lung infection
*[[Coeliac disease]]
*[[Community-acquired pneumonia]]
*[[Crohn's disease]]
*[[Cryoglobulinaemia]]
*[[Decompression sickness]]
*[[Deferiprone]]
*Diffuse idiopathic skeletal hyperostosis
*[[Dressler's syndrome]]
*[[Ehlers-Danlos syndrome]]
*[[Erythema elevatum diutinum]] (is a rare type of [[leukocytoclastic vasculitis]] characterized by red, purple, brown, or yellow [[papule]]s, [[plaque]]s, or [[nodule]]s)
*[[Farber's disease]]
*[[Fibromyalgia]]
*[[Fluorosis]]
*[[Fracture]] of bone
*[[Gout]]
*[[Graft versus host disease]]
*[[Haemochromatosis]]
*[[Haemophilia type A]]
*[[Henoch-Schönlein purpura]]
*[[Hepatitis]] [[Hepatitis A|A]], [[Hepatitis B|B]], [[Hepatitis C|C]]
*[[Hip dysplasia]], congenital
*[[Hyperimmunoglobulinemia D]] and [[periodic fever syndrome]] ( attacks of [[fever]], arthralgia, [[skin lesion]]s, and [[diarrhea]])
*[[Hypertrophic pulmonary osteoarthropathy]]
*[[Hypothyroidism]]
*[[Interstitial nephritis]]
*[[Isotretinoin]]
*Jacobs arthropathy-camptodactyly syndrome
*[[Juvenile chronic arthritis]]
*[[Kawasaki disease]]
*[[Lepromatous leprosy]]
*Lipoid dermatoarthritis
*[[Lupus erythematosus]]
*[[Lyme disease]]
*[[Malaria]]
*Mayaro virus fever
*[[Methimazole]]
*[[Mianserin]] ([[antidepressant]], also [[mirtazapine]] and [[nefazodone]] are associated with arthralgia)
*[[Mixed connective tissue disease]]
*[[Morphoea]]/[[scleroderma]]
*Multiple epiphyseal dysplasia
*[[Multiple myeloma]]
*[[Mycoplasma pneumoniae]]
*[[Nalidixic acid]]
*[[Nateglinide]]
*[[Norfloxacin]]
*[[Obesity]]
*O'nyong-nyong fever
*[[Osteoarthritis]]
*[[Osteochondritis]] dissecans
*[[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)
*[[Polyarteritis nodosa]]
*[[Polychondritis]], Relapsing
*Progressive pseudorheumatoid dysplasia
*[[Propylthiouracil]]
*[[Pyoderma gangrenosum]]
*[[Pyrazinamide]]
*[[Pyrophosphate arthropathy]] ([[Pseudogout]])
*[[Rat bite fever]] (Streptobacillus moniliformis or Spirillum minus)
*Recurrent hereditary polyserositis
*[[Rheumatic Fever]]
*Rheumatoid disease
*[[Ross River virus]]
*[[Rubella]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*Sclerosing osteomyelitis of Garre
*Secondary [[syphilis]]
*Semliki forest fever
*[[Serum sickness]]
*[[Sickle cell disease]]
*[[Sjögren's syndrome]]
*[[Stickler syndrome]]
*[[Still's Disease]], Juvenile-Onset
*[[Sweet's disease]]
*Synovial chondromatosis
*[[Systemic sclerosis]]
*[[Takayasu's arteritis]]
*[[Takayasu's arteritis]]
*[[Toxic shock syndrome]]
*[[Trastuzumab]]
*[[Trichinosis]]
*[[Ulcerative Colitis]]
*Urate crystal arthropathy ([[gout]])
*[[Waldenström macroglobulinemia]]
*[[Wegener's granulomatosis]]
*[[West Nile fever]]
*[[Whipple disease]]
*[[Wilson's disease]]
*Wissler-Fanconi syndrome
*Zotepine

===Complete Differential Diagnosis of the Causes of Arthralgia===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Dressler's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Bismuth]], [[Carbimazole]], [[Ciprofloxacin]], [[Deferiprone]], [[Fluorosis]], [[Isotretinoin]], [[Methimazole]], [[Mianserin]], mirtazapine, nefazodone,
[[Nalidixic acid]], [[Nateglinide]], [[Norfloxacin]], [[Propylthiouracil]], [[Pyrazinamide]]
[[Trastuzumab]], Zotepine
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Coeliac disease]], [[Crohn's disease]], [[Hepatitis]] A, B, C, [[Ulcerative Colitis]], [[Whipple disease]], [[Wilson's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Haemochromatosis]], [[Haemophilia type A]], [[Henoch-Schönlein purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Blau syndrome]], [[Borrelia burgdorferi]], [[Fibromyalgia]], [[Gout]],
[[Hip dysplasia]], congenital, Hypertrophic pulmonary osteo-arthropathy, Jacobs arthropathy-camptodactyly syndrome, Juvenile chronic 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]], Juvenile-Onset, Synovial chondromatosis, [[Systemic sclerosis]], [[Takayasu's arteritis]], [[gout]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Multiple myeloma]], [[Pigmented villonodular synovitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|"|[[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

==See also==
==References==
{{reflist|2}}

==External links==

{{Diseases of the musculoskeletal system and connective tissue}}
{{SIB}}

[[de:Arthralgie]]
[[fr:Arthralgie]]

[[Category:Rheumatology]]
[[Category:Signs and symptoms]]

[[pl:Artralgia]]

{{WH}}
{{WS}}

Arthralgia

2009-04-09T01:28:13Z

Johnfanisrour: /* Complete Differential Diagnosis of the Causes of Arthralgia */

{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 15237
| ICD10 = {{ICD10|M|25|5|m|20}}
| ICD9 = {{ICD9|719.4}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D018771
}}
{{SI}}
{{CMG}}

{{JFS}}

{{EH}}
==Overview==
'''Arthralgia''' (from Greek ''arthro-'', joint + ''-algos'', pain) literally means ''joint pain''; <ref name="medterms_arthralgia">
{{cite web
|url=http://www.medterms.com/script/main/art.asp?articlekey=2343
|title= Arthralgia Definition
|accessdate=2007-09-20
|format= HTML
|work=MedicineNet.com }}</ref><ref name="jgh_arthralgia"> {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Arthralgia
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref> it is a symptom of injury, infection, illnesses
-- in particular [[arthritis]]-- or an allergic reaction to medication.<ref name="drugReaction" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Allergic Drug Reactions - Systemic Allergic Drug Reactions
|author=James R Philp
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

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.<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?field=uid&term=D018771 |title=MeSH |accessdate=2007-12-23 |format= |work=}}</ref>

==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 <ref name="jgh_arthralgia"/>. 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.<ref name="jgh_arthralgia"/> <ref name="spondyl_table1" > {{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=arthralgia&rid=cm.chapter.5910#5949
|title= Table 159.3. Selected Symptomatic Extraarticular Features of the Connective Tissue Diseases and the Spondyloarthropathies
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>
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 [[Arthritic|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). <ref name="nihbook_2">{{cite web |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cm.chapter.4738
|title= Table 161.1. Some Common Regional Rheumatic Syndromes
|author=Joe G. Hardin
|accessdate=2007-09-20
|format= HTML
|work=Clinical Methods - The History, Physical, and Laboratory Examinations }}</ref>

==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]]
*[[Atypical pneumonia]]
*[[Behcet's disease]]
*[[Bismuth]]
*[[Blau syndrome]] (granulomatous [[arthritis]], [[iritis]], and [[skin rash]])
*[[Borrelia burgdorferi]] ([[Lyme Disease]])
*[[Bruton's agammaglobulinemia]]
*[[Caplan's disease]] ([[rheumatoid arthritis]] and [[pneumoconiosis]])
*[[Carbimazole]]
*[[Chikungunya virus]]
*[[Chikungunya]]
*[[Chronic fatigue syndrome]]
*[[Ciprofloxacin]] ([[Quinolone]]-induced cartilage toxicity in children)
*[[Coccidioidomycosis]] lung infection
*[[Coeliac disease]]
*[[Community-acquired pneumonia]]
*[[Crohn's disease]]
*[[Cryoglobulinaemia]]
*Decompression sickness
*[[Deferiprone]]
*Diffuse idiopathic skeletal hyperostosis
*[[Dressler's syndrome]]
*[[Ehlers-Danlos syndrome]]
*[[Erythema elevatum diutinum]] (is a rare type of [[leukocytoclastic vasculitis]] characterized by red, purple, brown, or yellow [[papule]]s, [[plaque]]s, or [[nodule]]s)
*[[Farber's disease]]
*[[Fibromyalgia]]
*[[Fluorosis]]
*[[Fracture]] of bone
*[[Gout]]
*[[Graft versus host disease]]
*[[Haemochromatosis]]
*[[Haemophilia type A]]
*[[Henoch-Schönlein purpura]]
*[[Hepatitis]] [[Hepatitis A|A]], [[Hepatitis B|B]], [[Hepatitis C|C]]
*[[Hip dysplasia]], congenital
*[[Hyperimmunoglobulinemia D]] and [[periodic fever syndrome]] ( attacks of fever, arthralgia, skin lesions, and diarrhea)
*Hypertrophic pulmonary osteo-arthropathy
*[[Hypothyroidism]]
*[[Interstitial nephritis]]
*[[Isotretinoin]]
*Jacobs arthropathy-camptodactyly syndrome
*Juvenile chronic arthritis
*[[Kawasaki disease]]
*[[Lepromatous leprosy]]
*Lipoid dermatoarthritis
*[[Lupus erythematosus]]
*[[Lyme disease]]
*[[Malaria]]
*Mayaro virus fever
*[[Methimazole]]
*[[Mianserin]] (antidepressent, also mirtazapine and nefazodone are associated with arthralgia)
*[[Mixed connective tissue disease]]
*[[Morphoea]]/[[scleroderma]]
*Multiple epiphyseal dysplasia
*[[Multiple myeloma]]
*[[Mycoplasma pneumoniae]]
*[[Nalidixic acid]]
*[[Nateglinide]]
*[[Norfloxacin]]
*[[Obesity]]
*O'nyong-nyong fever
*[[Osteoarthritis]]
*[[Osteochondritis]] dissecans
*[[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)
*[[Polyarteritis nodosa]]
*[[Polychondritis]], Relapsing
*Progressive pseudorheumatoid dysplasia
*[[Propylthiouracil]]
*[[Pyoderma gangrenosum]]
*[[Pyrazinamide]]
*[[Pyrophosphate arthropathy]] ([[Pseudogout]])
*[[Rat bite fever]] (Streptobacillus moniliformis or Spirillum minus)
*Recurrent hereditary polyserositis
*[[Rheumatic Fever]]
*Rheumatoid disease
*[[Ross River virus]]
*[[Rubella]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*Sclerosing osteomyelitis of Garre
*Secondary [[syphilis]]
*Semliki forest fever
*[[Serum sickness]]
*[[Sickle cell disease]]
*[[Sjögren's syndrome]]
*[[Stickler syndrome]]
*[[Still's Disease]], Juvenile-Onset
*[[Sweet's disease]]
*Synovial chondromatosis
*[[Systemic sclerosis]]
*[[Takayasu's arteritis]]
*[[Takayasu's arteritis]]
*[[Toxic shock syndrome]]
*[[Trastuzumab]]
*[[Trichinosis]]
*[[Ulcerative Colitis]]
*Urate crystal arthropathy ([[gout]])
*[[Waldenström macroglobulinemia]]
*[[Wegener's granulomatosis]]
*[[West Nile fever]]
*[[Whipple disease]]
*[[Wilson's disease]]
*Wissler-Fanconi syndrome
*Zotepine

===Complete Differential Diagnosis of the Causes of Arthralgia===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Dressler's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Bismuth]], [[Carbimazole]], [[Ciprofloxacin]], [[Deferiprone]], [[Fluorosis]], [[Isotretinoin]], [[Methimazole]], [[Mianserin]], mirtazapine, nefazodone,
[[Nalidixic acid]], [[Nateglinide]], [[Norfloxacin]], [[Propylthiouracil]], [[Pyrazinamide]]
[[Trastuzumab]], Zotepine
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Coeliac disease]], [[Crohn's disease]], [[Hepatitis]] A, B, C, [[Ulcerative Colitis]], [[Whipple disease]], [[Wilson's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Haemochromatosis]], [[Haemophilia type A]], [[Henoch-Schönlein purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Blau syndrome]], [[Borrelia burgdorferi]], [[Fibromyalgia]], [[Gout]],
[[Hip dysplasia]], congenital, Hypertrophic pulmonary osteo-arthropathy, Jacobs arthropathy-camptodactyly syndrome, Juvenile chronic arthritis, [[Lipoid dermatoarthritis]], [[Lupus erythematosus]], [[Lyme disease]], [[Mixed connective tissue disease]], [[sceleroderma]],
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 disease]], [[Scleroderma]], Sclerosing osteomyelitis of Garre, [[Sjögren's syndrome]], [[Still's Disease]], Juvenile-Onset, Synovial chondromatosis, [[Systemic sclerosis]], [[Takayasu's arteritis]], [[gout]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Multiple myeloma]], [[Pigmented villonodular synovitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|"|[[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]],[[sceleroderma]], [[Polyarteritis nodosa]], [[Polychondritis]], Relapsing [[Pyoderma gangrenosum]], [[Rheumatic Fever]], [[Rheumatoid disease]], [[Sarcoidosis]], [[Scleroderma]] , [[Serum sickness]], [[Sjögren's syndrome]], [[Still's Disease]], [[Systemic sclerosis]], [[Takayasu's arteritis]], [[Takayasu's arteritis]], [[Wegener's granulomatosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

==See also==
==References==
{{reflist|2}}

==External links==

{{Diseases of the musculoskeletal system and connective tissue}}
{{SIB}}

[[de:Arthralgie]]
[[fr:Arthralgie]]

[[Category:Rheumatology]]
[[Category:Signs and symptoms]]

[[pl:Artralgia]]

{{WH}}
{{WS}}