joint disease; articular disease; arthropathy

Introduction

Joint disease characterized by 3 parameters:

• acute vs chronic
• inflammatory vs non-inflammatory
• 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

• synovial fluid
  • appearance
    • normal & non-inflammatory: clear/yellow/transparent
    • inflammatory & crystalline arthropathy: yellow/white/translucent/opaque
    • infectious: yellow/white/opaque
    • hemorrhagic: red/opaque
  • 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)
  • gram stain & culture for suspected infectious etiology
• erythrocyte sedimentation rate is elevated with inflammatory arthritis
• C-reactive protein in serum is elevated with inflammatory arthritis
• complete blood count (CBC): anemia of chronic inflammation
• serology: see autoantibodies in rheumatologic disease

More general terms

• musculoskeletal disease/disorder

More specific terms

• 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

Additional terms

• age-associated changes in the skeletal system
• joint