Diagnosis and Management of Acute Joint Pain for the Urgent Care Clinician (Pharmacology CME and Pain Management CME)

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Delivery Method:	Online
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Publication Date: December 2023 (Volume 2, Number 12)

CME Credits: 4 AMA PRA Category 1 Credits™, and 4 AOA Category 2-B CME credits. CME expires 12/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology and 1 Pain Management CME credits, subject to your state and institutional requirements.

Authors

Peer Reviewers

Coding Author

Abstract

Acute monoarticular and polyarticular joint pain can result from infection, trauma, autoimmune, or inflammatory processes. All types may be a major cause of disability that is often preventable with early diagnosis and management. Septic arthritis presents a particular danger, with a high potential for morbidity and mortality. This issue presents an overview of various types of acute joint pain that may present to urgent care, and outlines systematic, evidence-based strategies for diagnosis and treatment. Emerging infectious and reactive causes of arthritis, including Zika, chikungunya, and others are reviewed. Best-practice recommendations for treatment and disposition as well as indications for emergent consultation, emergency evaluation, or specialty referral are also highlighted.

Case Presentations

A 43-year-old man arrives with complaints of severe pain in his left knee...

• He is unable to ambulate. There is no history of trauma, travel, or rash.
• You are surprised by his vital signs: temperature: 39.2°C; blood pressure: 100/70 mm Hg; heart rate, 116 beats/min; respiratory rate, 22 breaths/min; and SPO2 of 98% on room air.
• You wonder if the patient can be managed in the urgent care, or if he would be better served in the local ED...

A 27-year-old woman is brought into the urgent care clinic with complaints of severe, diffuse joint pain...

• She returned last week from the Dominican Republic, where she was on her honeymoon. She also describes subjective fevers.
• Her temperature is 39.2ºC; blood pressure, 130/75 mm Hg; and respiratory rate, 18 breaths/min.
• The nurse approaches you with the concern that the patient has a diffuse rash and asks whether the patient should be isolated...

A 72-year-old woman with diabetes and hypertension presents for her third episode of redness and swelling of her right great toe...

• She states even the sheets lying on the area cause pain.
• She was previously diagnosed with cellulitis and given antibiotics.
• Her vital signs are normal.
• There is an obvious effusion of the joint. Range of motion is preserved but painful.
• She admits to dietary indiscretion of eating a lot of red meat and processed food, and admits to excessive alcohol intake prior to each episode...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.