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Ask the Experts
Joint pains are common and they can impact the daily routine. Thus, having proper check up will help you eliminate the pain and lead a normal life. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.
In people with pain in more than one joint, symptoms that should prompt rapid evaluation include
- Joint swelling, warmth, and redness
- New rashes, spots, or purple blotches
- Sores in the mouth or nose or on the genitals
- Chest pain, shortness of breath, or new or severe cough
- Abdominal pain
- Fever, sweats, weight loss, or chills
- Eye redness or pain
- When to see a doctor
People with warning signs should see a doctor right away. People without warning signs should call a doctor. The doctor decides how quickly they need to be seen based on the severity and location of pain, whether joints are swollen, whether the cause has been diagnosed previously, and other factors. Typically, a delay of several days or so is not harmful for people without warning signs.
The following tests are the most important overall:
- Tests of joint fluid
- Blood tests for auto antibodies
- Erythrocyte sedimentation rate (ESR) and C-reactive protein
If joints are swollen, doctors usually insert a needle into the joint to take a sample of the fluid in the joint for testing (a procedure called joint aspiration or arthrocentesis). Doctors numb the area before taking a sample, so people experience little or no pain during the procedure. Doctors generally do a culture on the fluid to see whether infection is present. They look under a microscope for crystals in the fluid, which indicate gout or related disorders. The numbers of white blood cells in the fluid indicate whether the joint is inflamed.
Doctors also often do blood tests for auto antibodies. Examples of such tests are antinuclear antibodies, anti–double-stranded DNA, anticyclic citrullinated peptide, and rheumatoid factor. Auto antibodies in the blood may indicate an autoimmune disorder such as rheumatoid arthritis or systemic lupus erythematosus.
The ESR is a test that measures the rate at which red blood cells settle to the bottom of a test tube containing a blood sample. Blood that settles quickly typically means that body wide (systemic) inflammation is likely, but many factors can affect the ESR test including age and anemia, so the test is sometimes inaccurate. To help determine whether body wide inflammation is present, doctors sometimes do another blood test called C-reactive protein (a protein that circulates in the blood and dramatically increases in level when there is inflammation).
Imaging tests are sometimes necessary, especially if there is a possibility of bone or joint tumors. X-rays are done first, but sometimes computed tomography (CT) or magnetic resonance imaging (MRI) is needed. If a particular disorder is suspected, other tests may be required (see table Some Causes and Features of Pain in More Than One Joint).
- Acute pain in multiple joints is most often due to inflammation, gout, or the beginning or flare up of a chronic joint disorder.
- Chronic pain in multiple joints is usually due to osteoarthritis or an inflammatory disorder (such as rheumatoid arthritis) or, in children, juvenile idiopathic arthritis.
- When significant fluid accumulates inside of a joint, a fluid sample usually must be withdrawn and tested.
- Lifelong physical activity helps maintain range of motion in people with chronic arthritis.