Mechanical versus inflammatory presentations Flashcards
What is a mechanical condition?
Wear and tear Overuse An internal joint derangement An injury Osteoarthritis
What is an inflammatory condition?
(1) Systemic arthritis: rheumatoid arthritis, SLE, psoriatic arthropathy, arthritis from inflammatory bowel disease.
(2) Acute gout (doesn’t follow rules)
What are other joint conditions that don’t fit into the ‘mechanical’ and ‘inflammatory’ conditions but should not be missed?
Septic arthritis/osteomyelitis
Neoplasia
Doctor 5
Where is the problem? What is the problem? How is this problem affecting you/your life? Why do you think you have this problem? Why have you presenting now?
Typical mechanical presentation
Pain worse with activity and better with rest
Minimal stiffness (less than 30 minutes)
May be crepitus, locking
Typical inflammatory presentation
Pain better with activity and worse with rest
Morning stiffness (more than 30 minutes)
Stiffness at rest
Important questions
(1) General: tell me more about…
(2) Specific: time of day, affect of activity and rest, night pain.
(3) Other history: stiffness and duration of stiffness (1hour=inflammatory)
(4) Associated symptoms: stiffness, rash, fever, weight loss, fatigue.
Exceptions
Keep an open mind
Inflamed joint can hurt during activity
Osteoarthritic joints can feel stiff
Degenerative arthritis can present in an inflammatory pattern
Conditions not to be missed
Always consider malignancy with rest pain and especially night pain
Always ask yourself is there any sign of joint infection (septic arthritis)
Septic arthritis
Pain and swelling
heat locally/fever
Infection present
May be similar presentation to gout and pseudogout
Signs of neoplasia
Night pain Constitutional symptoms (weakness, anorexia, weight loss)
Signs of septic arthritis
Pain
Swelling
Heat-fever
