Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 11/1/2025

Differential Diagnoses for Joint Pain

Inflammatory Arthropathies

  • The European League Against Rheumatism recommends considering rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis as potential differential diagnoses for joint pain 1, 2, 3, 4
  • The American College of Rheumatology suggests that reactive arthritis and ankylosing spondylitis should also be considered in the differential diagnosis of joint pain 2, 4, 5

Crystal Arthropathies

  • The European League Against Rheumatism recommends considering gout and pseudogout (CPPD) as potential differential diagnoses for joint pain, with a strength of evidence rated as high 1, 2, 3
  • Chronic tophaceous gout is a potential differential diagnosis for joint pain, particularly in patients with a history of gout 1

Infectious Causes

  • The Infectious Diseases Society of America recommends considering septic arthritis as a potential differential diagnosis for joint pain, with a strength of evidence rated as high 2, 6
  • Infectious osteomyelitis and viral arthritis are also potential differential diagnoses for joint pain 1, 2

Degenerative Conditions

  • The American College of Rheumatology recommends considering osteoarthritis as a potential differential diagnosis for joint pain, with a strength of evidence rated as high 1, 2, 3, 4, 6

Connective Tissue Diseases

  • The American College of Rheumatology suggests that systemic lupus erythematosus should be considered in the differential diagnosis of joint pain, particularly in patients with a history of autoimmune disorders 4, 5

Inflammatory Myopathies and Soft Tissue Disorders

  • The American College of Rheumatology recommends considering polymyalgia rheumatica and myositis as potential differential diagnoses for joint pain, with a strength of evidence rated as moderate 2, 6, 9
  • Fibromyalgia and rotator cuff tendinitis are also potential differential diagnoses for joint pain 2, 6

Bone Disorders

  • The American College of Rheumatology recommends considering osteonecrosis as a potential differential diagnosis for joint pain, particularly in patients with a history of trauma or steroid use 4, 5
  • Chronic non-bacterial osteitis (CNO), Paget's disease, and malignant bone tumor are also potential differential diagnoses for joint pain 1

Metabolic and Endocrine

  • The American College of Rheumatology suggests that haemochromatosis and ascorbic acid deficiency should be considered in the differential diagnosis of joint pain, particularly in patients with a history of metabolic or endocrine disorders 1, 3
  • The American Society of Clinical Oncology recommends considering ICPi-induced arthritis and ICPi-induced polymyalgia-like syndrome as potential differential diagnoses for joint pain in patients receiving immune checkpoint inhibitors, with a strength of evidence rated as moderate 2, 6, 9

Rare Causes

  • The American College of Rheumatology suggests that sarcoidosis (osseous manifestations), Langerhans cell histiocytosis, and Erdheim-Chester disease should be considered in the differential diagnosis of joint pain, particularly in patients with a history of rare disorders 1

Drug-Induced

  • The American College of Rheumatology recommends considering statin-induced myopathy and infliximab-related lupus-like syndrome as potential differential diagnoses for joint pain in patients receiving these medications, with a strength of evidence rated as moderate 2, 4, 5, 6

REFERENCES

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