Inflammatory and Non-Inflammatory Joint Pain

Question 1

What are the inflammatory causes of joint pain?

Answer 1

Infection Crystal arthritis Auto-immune (Rheumatoid arthritis, Spondylo-arthropathy (HLA-B27), Connective tissue disease)

Question 2

What are the non-inflammatory causes of joint pain?

Answer 2

Degenerative e.g. osteoarthritis Non-degenerative e.g. fibromyalgia

Question 3

How can crystal disease and infection be differentiated from auto-immune inflammatory joint disorders?

Answer 3

Crystal and infection: More rapid onset Very red and hot joints Relevant clinical history (Gout: diuretics, obestiy, hypertension, alcohol) (Infection: bacteraemia, age, immunosuppressed)

Question 4

Draw a 7x2 table showing how inflammatory joint pain can be differentiated from non-inflammatory joint pain.

Answer 4

Inflammatory

1. Pain eases with use
2. Stiffness (significant >60 mins, early morning and at rest (evening))
3. Swelling (synovial +/- bony)
4. Hot and red
5. Young, psoriasis, fhx
6. Distribution hands and feet
7. Responds to NSAIDS

Degenerative

1. Pain increases with use
2. Stiffness (not prolonged <30m, morning/evening)
3. Swelling (not synovial, bony only)
4. Not clinically inflammed
5. Older, obesity, occupation
6. Distribution, DIPJ, PIPJ, Hips, Knees.
7. Poor response to NSAIDs