| Monoarticular arthritis
| Polyarticular arthritis
| Rheumatoid arthritis
| Septic Arthritis
|Systemic Lupus Erythematosus (SLE)
- Polyarticular arthritis > 5 joints affected
- First determine if inflammatory or non-inflammatory
- Inflammatory have more Pain, Stiffness Swelling, Nighttime pain and morning stiffness than non-inflammatory
Age and Gender related Differentials
- Reactive arthritis (M>F)
- Systemic lupus erythematosus (F>M)
- Ankylosing spondylitis (M>F)
- Rheumatoid arthritis (F>M)
- Sjögren’s syndrome (F>M)
- Psoriatic arthropathy
- Enteropathic arthropathy
- Middle age
- Gout (M>F)
- Rheumatoid arthritis (F>M)
- Polymyalgia rheumatica
Joint sepsis is an emergency and needs urgent diagnosis with joint aspiration and treatment
Differentials: See individual topics for more
| Rheumatoid arthritis || Symmetrical, any joint, legs and arm on over hours. Usually spares the hip and knees and elbows and DIP. Severe pain. Usually, 1st MTP. Red hot. Elevated CRP/ESR Anti-CCP. Positive RF Aspirate joint if diagnosis uncertain need to exclude sepsis. Examine for crystals. Recent dehydration, operation |
|Reactive Arthritis ||Comes on over days. Symmetrical small joints, rash and prodromal symptoms. Viral, Lyme disease. |
|Osteoarthritis || Variable Symmetrical, DIP joints, knees, hips, back and neck, Heberden's, Bouchard's. Bloods normal |
|Psoriatic arthritis ||Male, Asymmetrical PIP and DIP joints, nail changes. Pitting, onycholysis, Skin rash. |
|Ankylosing spondylitis || Large joints, Lower > upper. Back pain. Younger age. |
|Systemic lupus erythematosus || Females, Butterfly rash, Symmetrical, small join, synovitis |
- The presence of the cardinal signs of inflammation on physical examination
- Erythema, warmth, swelling, and tenderness, confirms inflammatory arthritis.
- Noninflammatory arthritis may have swelling and tenderness, but does not cause erythema or warmth
- Crepitation without warmth or erythema suggests a degenerative process, such as osteoarthritis.
- Joint swelling, erythema, prolonged morning stiffness (more than one hour), and symmetric pain even at rest are suggestive of inflammatory conditions.
- Weight bearing and movement worsen the pain of noninflammatory arthritis conditions, such as osteoarthritis.
- Noninflammatory and inflammatory conditions can be differentiated with C-reactive protein and erythrocyte sedimentation rate tests; however, in the acute phase, erythrocyte sedimentation rate is less reliable than C-reactive protein.
- In the diagnosis of gout, a high serum uric acid level has little diagnostic value. The standard of diagnosis is the presence of intracellular monosodium urate crystals on polarized microscopy.
- Osteoarthritis is noninflammatory; is typically pauciarticular; and often involves the spine and weight-bearing joints, such as the hips and knees.
- Do not test antinuclear antibody sub serologies without a positive antinuclear antibody test result and clinical suspicion of immune-mediated disease.
- Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate examination findings.