Arthralgia

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

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Overview

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

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

Diagnosis and Causes

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

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

Treatment

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

Complete Differential Diagnosis of the Causes of Arthralgia

(In alphabetical order)

• Acute lymphoblastic leukemia
• Acromegaly
• 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 papules, plaques, or nodules)
• Farber's disease
• Fibromyalgia
• Fluorosis
• Fracture of bone
• Gout
• Graft versus host disease
• Haemochromatosis
• Haemophilia type A
• Henoch-Schönlein purpura
• Hepatitis A, B, C
• Hip dysplasia, congenital
• Hyperimmunoglobulinemia D and periodic fever syndrome ( attacks of fever, arthralgia, skin lesions, 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)

Cardiovascular	Dressler's syndrome
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Bismuth, Carbimazole, Ciprofloxacin, Deferiprone, Fluorosis, Isotretinoin, Methimazole, Mianserin, mirtazapine, nefazodone, Nalidixic acid, Nateglinide, Norfloxacin, Propylthiouracil, Pyrazinamide Trastuzumab, Zotepine
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, Obesity
Environmental	No underlying causes
Gastroenterologic	Coeliac disease, Crohn's disease, Hepatitis A, B, C, Ulcerative Colitis, Whipple disease, Wilson's disease
Genetic	No underlying causes
Hematologic	Haemochromatosis, Haemophilia type A, Henoch-Schönlein purpura
Iatrogenic	No underlying causes
Infectious Disease	Atypical pneumonia, Borrelia burgdorferi, Lyme Disease, Chikungunya virus, Coccidioidomycosis lung infection, Community-acquired pneumonia Hepatitis A; B; C, Lepromatous leprosy, Lyme disease, Malaria, Mayaro virus fever, Mycoplasma pneumoniae, O'nyong-nyong fever, Parvovirus B19 infection, Pharyngitis, Rat bite fever, Rheumatic Fever, Ross River virus, Rubella, syphilis, Semliki forest fever, Serum sickness, Toxic shock syndrome, Trichinosis, West Nile fever, Whipple disease
Musculoskeletal / Ortho	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
Neurologic	No underlying causes
Nutritional / Metabolic	Obesity
Obstetric/Gynecologic	No underlying causes
Oncologic	Acute lymphoblastic leukemia, Multiple myeloma, Pigmented villonodular synovitis
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	"|Behcet's disease, Caplan's disease, Coeliac disease, Crohn's disease, Dressler's syndrome, Erythema elevatum diutinum, Hypothyroidism, Juvenile chronic arthritis, Lupus erythematosus, Mixed connective tissue disease,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
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes