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Approach to Joint Complaints

Uzma Haque MD and Neda Frayha, MD
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19:05
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Do you have a super amazing approach to patients with joint complaints? If not, you will after listening to this practical conversation between Neda and Dr. Uzma Haque, a rheumatologist and arthritis expert at Johns Hopkins. 

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Alan R., M.D. -

If one suspects inflammatory arthritis, would it be helpful to also check ESR/CRP (even though nonspecific)?

Neda F., MD -

Hi Alan! Here is Dr. Haque's response:
"Yes, we do evaluate ESR and CRP but these numbers do NOT solely drive our assessment. For example, in a patient with inflammatory joint symptoms, a normal ESR or CRP will not sway me away from my clinical suspicion. Hope that helps."

Michael S. -

I was excited to hear this podcast but then disappointed a few times.
First of all, while recognizing that there are lots of inflammatory arthritides, unless I missed it, the idea of diagnostic criteria for these conditions did not come up in the lecture.
Rheumatology uses diagnostic lists in books like "Primer on the Rheumatic Diseases" like Psychiatry uses the DSM to guide diagnosis and management. Saying "Well you have some swollen joints, morning stiffness and maybe a rash so let's do a RF, ANA and CCP on you!" seems quite incomplete. There are 11 criteria, for example, for SLE. You have to have at least four, one of which is serology, so if the patient comes in with one or two of the other criteria, an ANA isn't going to make your diagnosis. Same with RA and PSS/scleroderma (I don't know why you had to change the name to a longer name). By emphasizing the serology without mentioning the diagnostic criteria, the FP's role becomes simplified to "You have swollen joints. I'm going to order some blood tests and refer you to someone else to figure out the problem." I think we can do better.

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Hippo Primary Care November 2020 Written Summary 254 KB - PDF

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