A 23-year-old female college student presents to student health service with a 2-week history of “aches and pains.” She has noticed stiffness in the morning lasting approximately 1 hour and affecting her hands, feet, ankles, and shoulders. She notes that 3 days ago she had some shaking chills and a fever. She is sexually active. Her sexual partner uses condoms. 

CC: “I am very tired out from these aches and pains. What is wrong with me?”

Physical exam demonstrates tenderness in multiple joints. Specifically, tenderness is noted in several extra-articular locations, consistent with bursitis and tenosynovitis. Her right knee is swollen and warm with a large effusion. All other joints demonstrate full range of motion with no evidence of effusion, joint swelling, or deformity. 

Questions:

1. List at least 3 differential diagnoses. 
2. How would you distinguish whether this patient had      myalgias, arthralgias, arthritis, bursitis, or tenosynovitis? Define and      review these terms. 
3. How would you manage this patient? What health      promotion strategies are especially important for this patient at this      point in time and WHY? 
4. What complementary therapies might be effective for      this patient? Always support with evidence from the literature.