Presence of articular involvement

It is important to differentiate the potential source of the person’s symptoms.

Articular (joint) involvement may be associated with joint-line tenderness, pain on passive joint movement, joint effusion or swelling with loss of normal skin creases around the joint. Articular inflammation (eg synovitis) is suggestive of an inflammatory rheumatological disease.

Periarticular pain may be felt in muscles, bones, ligaments, tendons, entheses (sites of tendon and ligament attachment to bone) and bursae that are adjacent to joints. Examples include injuries, such as muscle strain, ligament sprain and tendinopathy. Enthesitis and bursitis can mimic inflammatory rheumatological conditions.

Nonarticular pain may resemble either articular or periarticular pain but is associated with distant pathology (eg arm pain referred from cervical radiculopathy, shoulder pain referred from diaphragmatic irritation, back pain referred from an aortic aneurysm).