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joint disease; articular disease; arthropathy
Joint disease characterized by 3 parameters:
1) acute vs chronic
2) inflammatory vs non-inflammatory
3) monoarticular vs oligoarticular (2-4 joints) vs polyarticular
Etiology:
- acute inflammation
- monoarticular: bacterial infection, crystalline arthropathy
- oligoarticular: disseminated gonococcal infection, rheumatic fever, Lyme disease
- polyarticular: hepatitis A, hepatitis B, parvovirus, rubella, HIV1
- chronic inflammation
- monoarticular: mycoses, mycobacteria, syphilis, Lyme disease
- oligoarticular: spondyloarthropathy
- polyarticular:
- rheumatoid arthritis, lupus (SLE), psoriatic arthritis, crystalline arthropathy
- chronic without inflammation
- monoarticular: osteoarthritis
- oligoarticular: osteoarthritis
- polyarticular: osteoarthritis
Clinical manifestations:
- inflammatory:
- erythema, warmth, edema
- morning stiffness > 60 minutes
- constitutional symptoms: fever, fatigue, malaise
- non-inflammatory
- no erythema, minimal warmth, no edema, bony enlargement, joint effusion
- morning stiffness < 30 minutes
- constitutional symptoms: usually none
Laboratory:
1) synovial fluid
a) appearance
- normal & non-inflammatory: clear/yellow/transparent
- inflammatory & crystalline arthropathy: yellow/white/translucent/opaque
- infectious: yellow/white/opaque
- hemorrhagic: red/opaque
b) leukocyte count
- < 200/uL is normal
- 200-2000/uL (non-inflammatory), predominantly monocytes
- 2000-20,000/uL or higher (inflammatory)
- predominantly neutrophils (acute), monocytes (chronic)
- 10,000-50,000/uL (crystalline arthropathy)
- > 50,000/uL may be lower (infectious arthropathy)
c) gram stain & culture for suspected infectious etiology
2) erythrocyte sedimentation rate is elevated with inflammatory arthritis
3) C-reactive protein in serum is elevated with inflammatory arthritis
4) complete blood count (CBC): anemia of chronic inflammation
5) serology: see autoantibodies in rheumatologic disease
Related
age-associated changes in the skeletal system
joint
Specific
2nd & 3rd metacarpophalangeal (MCP) arthropathy
abscess of bursa
acromioclavicular joint degeneration; acromioclavicular arthritis
ankylosis
arthritis
arthrogryposis
bunion
cervicocranial syndrome
cheiroarthropathy
cheiropathy
claw toe
Clutton's joints
costochondritis (Tietze syndrome)
degenerative joint disease (DJD)
enthesopathy (enthesitis)
femoroacetabular impingement
hallux limitus/rigidus
hallux valgus
hallux varus
hammertoe; hallux malleus; digiti flexus
hemarthrosis
joint deformity
joint dislocation
joint instability
joint mouse
mallet finger
osteoarthropathy
pachydermodactyly
pigmented villonodular synovitis (PVNS)
Plica syndrome
polymyalgia arthralgia syndrome (PMAS)
rotator cuff disease
Stickler syndrome or hereditary progressive arthroophthalmopathy
synostosis
synovial chondromatosis; Reichel's syndrome; Reichel-Jones-Henderson syndrome
synovial osteochondromatosis (SOC)
temporomandibular joint (TMJ) syndrome
General
musculoskeletal disease/disorder
References
- Waits JB.
Rational use of laboratory testing in the initial evaluation
of soft tissue and joint complaints.
Prim Care. 2010 Dec;37(4):673-89,
PMID: 21050950
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022