Diagnosis and Treatment

· Diagnosis of joint pain is based on physical examination (see “Diagnostic Criteria”), X-ray, MRI,
examination of synovial effusion, and blood tests.
· X-rays can document deformation, loss of cartilage, rupture of ligaments, etc.
· MRI scans can document synovial hyperplasia, bone marrow edema, and other soft-tissue alterations.
· Blood tests are used to check inflammatory markers.
· For treatment of pain, analgesic drugs (usually nonsteroidal anti-inflammatory drugs) are commonly used.
· Physical therapy, exercise, education, and TENS are effective in arthritic pain conditions.
· Specific treatments include (1) the use of disease-modifying drugs (e.g., neutralization of tumor necrosis
factor alpha) in order to stop the progression of rheumatoid arthritis; and (2) surgical joint replacement.
References
1. Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol 2005;17:624–8.
2. Schaible HG. Basic mechanisms of deep somatic pain. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s
textbook of pain, 5th ed. Elsevier: Churchill Livingstone; 2006. p. 621–33.
3. Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain 1993;55:5–54.
4. Scott DL. Osteoarthritis and rheumatoid arthritis. In: Wall and Melzack’s textbook of pain, 5th ed. Elsevier: Churchill
Livingstone; 2006. p. 653–67.