Not So Ordinary Joint Pain - What Could It Be?

Ike B; Nguyen V; Jaqua EE

Case Report

J Fam Med. 2021; 9(3): 1296.

Not So Ordinary Joint Pain - What Could It Be?

Ike B, Nguyen V and Jaqua EE*

Department of Family Medicine, Loma Linda University Health, USA

*Corresponding author: Ecler Ercole Jaqua, Department of Family Medicine, Loma Linda University Health, 1220 California Street, Redlands, CA 92374, USA

Received: February 26, 2022; Accepted: March 09, 2022; Published: March 16, 2022

Introduction

Musculoskeletal concerns are a common concern in busy primary care practice. When the musculoskeletal concern is a manifestation of systemic inflammation, as in inflammatory spondyloarthropathy, its early diagnosis is critical in preventing progression to irreversible joint damage, disability, morbidity, and mortality.

This case explores an atypical presentation of inflammatory spondyloarthropathy in patients without a significant medical history.

Case Presentation

A 25-year-old male with a past medical history significant for allergies and eczema presents to his PCP with a concern of right shoulder pain for the last three months. He denies any history of injury or trauma. The shoulder pain is worse with activity and improves with rest. The pain was unresponsive to over-the-counter acetaminophen or ibuprofen. He also reports a previous history of pain in his right hip, left knee, and left ankle. He expresses frustrations with multiple joint pains over the years that have limited his desired activity level. He reports an active lifestyle that includes regular exercise and weightlifting at least three times a week.

Physical examination:

Vital Signs: Afebrile, normotensive.

General: Well-appearing male in no acute distress

Musculoskeletal:

Right shoulder: Limited active and passive range of motion, provocative testing negative.

Right Hip: Lumbar paraspinal tenderness, pain at bilateral posterior superior iliac spine, normal range of motion.

Left Knee: Tender to palpation along the patellar tendon, provocative testing negative.

Left ankle: Trace effusion, normal range of motion.

The patient was referred for laboratory evaluation, plain radiographs, and physical therapy. In addition, he was advised to schedule a 4-6-week follow-up appointment.

Diagnostic testing

Labs were significant for elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Complete blood count and metabolic panels were within normal ranges. Thyroid testing was negative. Antinuclear antibody and rheumatoid factor negative.

Joint aspiration of the ankle was negative for crystals, and cell counts were normal.

Radiographs of the affected joints were significant for bilateral sacroiliac joint sclerosis (Figure 1).

Not So Ordinary Joint Pain - What Could It Be?

Introduction

Case Presentation

Diagnostic testing

Abstract

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References