Wednesday, April 26, 2017

Differential Diagnosis Of Joint Disorders

Disorders of joint is one of the common problem a family physician comes across. Here is a list of differential diagnosis for joint disorders with brief description of each disorder:

1. Congenital Causes

Achondroplasia: Premature osteoarthritis may occur in achondroplasia.

Ehlers-Danlos syndrome: a genetic disorder of connective tissues in which patients have hypermobile joints and hyperextensible skin. they may present with joint subluxation, dislocations and swelling due to effusions.

Marfan Syndrome: Patients have generalized joint laxityand present with joint pain and swelling due to effusions.

Osteogenesis Imperfecta: Patients have brittle bones that lead to easy joint dislocations.

2. Accquired Causes

  • Septic or pyogenic arthritis usually present as a monoarthritis with a red , swollen, painful, immobile joint. Usually a single joint is involved.
  • Viral arthritis may occur following viral illness like rubella, mumps, hepatitis etc.
  • In rheumatic fever which usually follows a streptococcal infection. There is a migratory poly arthritis together with carditis, erythematous skin lesions and sub cutaneous nodules.
  •  Rheumatoid arthritis presents initially with swollen, painful, stiff hands and feet. Later characteristic deformities develop. Most commonly swelling is seen at metacarpophalangeal joints.
  • Psoriatic arthropathy usually follows several years after skin lesions.
  • Reiter’s disease may present with arthritis in a single or few joints. There will be a history of sexual contact, urethritis and conjunctivitis.
  • Ankylosing spondylitis presents in young males and initially presents with morning stiffness in the spine. The sacroilliac joints are involved.
  • SLE presents with malaise arthralgia, myalgia, a butterfly rash on the face, raynaud’s syndrome, splenomegaly, pleurisy, pleural effusion, pericarditis.
  • Polymyalgia rheumatica is associated with tender muscles, mild polyarthritis and there may be associated temporal arteritis.
  • Osteoarthritis usually occurs after the age of 50 unless it is secondary to previous joint pathology. The patient complains of pain on movement, worse at theend of the day together with stiffness, swelling and instability of joints.
– Enteropathic
  • Due to acutes gastrointestinal infections, 
  • Inflammatory bowel disease or 
  • gastrointestinal bypass surgery.

Endocrine Causes e.g acromegaly

  • Gout
  • Hemochromatosis
  • Charcot’s joints: there may be history of diabetes, tabes dorsalis(syphilis), syringomyelia or leprosy
  • Haemophilia
  • Leukaemia
  • Sickle cell disease
  • Anticoagulants
  • Steroids
  • Rarely a patient will present with direct infiltration of a joint with malignant disease

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