Disease-specific signs and symptoms in patients with inflammatory joint diseases

Extract

• See Osteoarthritis of the hip and knee2.
• Osteoarthritis starts as mild joint inflammation, which may initially arouse a suspicion of, for example, recent onset rheumatoid arthritis. It may therefore be confused with proper inflammatory diseases. However, over time the character of osteoarthritis proves to be different.
• Characteristic symptoms are pain on exertion, followed by aching.
• Morning stiffness can occur, but it lasts for no longer than 15 minutes. The intensity of morning stiffness is also less marked than in inflammatory conditions. Particularly in rheumatoid arthritis morning stiffness lasts for several hours and is of high intensity. Osteoarthritis is associated with joint stiffness at the initiation of movement.
• In osteoarthritis of the knee, an early symptom may be minor joint effusion and pain caused by inappropriate joint loading. The overlying skin remains cool to the touch, or at the most slightly warm. Thickened synovium is rare, and it feels flexible on palpation. Only a small number of leucocytes (usually less than 2 000 × 10⁶/l) are present in the synovial fluid, with a predominance of mononuclear cells.
• Osteoarthritis of the fingers causes pain and reduced functioning. Sharp pain occurs during and after use in the affected small joints, occasionally accompanied by aggressive inflammation, the end result being a deterioration in the ability to perform activities of daily living. Hard, bony thickening will gradually form around the joints; at the distal interphalangeal (DIP) joints these are called Heberden's nodes and at the proximal interphalangeal (PIP) joints Bouchard's nodes. Flexion deficit is usually small (usually not more than 20 mm; see Clinical diagnosis of joint inflammation in the adult3), but in some cases the fingers may become crooked and the grip power is diminished. ESR and CRP are normal, and rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are usually negative.
• One of the typical sites for osteoarthritis is the first carpometacarpal joint (CMC 1). The thumb is turned into adduction and the back of the hand takes a squarish shape.
• Osteoarthritis can be roughly divided into two groups: oligoarticular large joint osteoarthritis and osteoarthritis of the small joints of the hand. Moreover, it is possible for osteoarthritis to affect the entire skeleton or any single joint. Unlike rheumatoid arthritis, osteoarthritis seldom affects the radiocarpal joint of the wrist.
  • Dorsiflexion of the wrists is tested by pressing the palms with straightened fingers against each other (picture 1). The respective test for volar flexion is performed by pressing the backs of the hands against each other (video Restricted motion of the wrist in a patient with rheumatoid arthritis1).

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A69.2, Arthritis, Arthritis, Infectious, Arthritis, Psoriatic, Arthritis, Reactive, Arthritis, Rheumatoid, Chondrocalcinosis, Dactylitis, Gonococcal arthritis, Gout, Heberden's nodes, I00, Infectious diseases, Internal medicine, L40.5+, Lupus Erythematosus, Systemic, Lyme Disease, M00, M02, M03.2*, M05, M05.9, M06, M06.0, M06.9, M07.4*, M07.5*, M10, M11, M13, M14, M14.8*D86.8, M15, M16, M17, M18, M19, M31.5, M32, M35.3, M45, M89.4, Monoarthritis, Morning stiffness, Orthopaedics, Osteoarthritis, Osteoarthropathy, primary hypertrophic, Polyarthritis, Polymyalgia Rheumatica, Rheumatic Fever, Rheumatology, Sarcoidosis, Spondylarthropathies, Spondylitis, Ankylosing, Synovial Fluid, Synovial leucocytes, Togaviridae infections, Viral arthritis