Pain in and around joints

A 55 year old woman presents with several months of bilateral knee pain. The pain is exacerbated by activity and improves with rest. She experiences approximately 10-15 min. of morning stiffness each day but otherwise denies constitutional complaints such as fever, anorexia, weight loss, or fatigue.

 She is moderately obese. None of her joints are warm, swollen, or tender. Aside from some crepitus with passive movement, examination of her knees is normal. The PIP and DIP joints are enlarged but nontender in both hands. Plain film of the right knee shows narrowing of the medial compartment joint space.

 Differential Dx
Osteoarthritis Rheumatoid arthritis Acute gout

 Osteoarthritis is characterized by degeneration of cartilage and often is associated with overuse or trauma to the joint Symptoms: pain, stiffness, loss of joint mobility, crepitus w joint mvmt Worse with joint use and improves w rest Nonsymmetrical PIP/DIP, knees, hips

 Rheumatoid arthritis is autoimmune damage of synovial membrane with secondary erosion of adjacent cartilage and bone Autoimmuneinflammationwarm/red jts Symmetrical PIP, feet, wrists, knees, elbows, ankles 1 hour morning stiffness Weakness, fatigue, low fever, weight loss

 A 42 year old woman presents with the complaint of feeling sore all over and constant aching pain. She also complains of persistent fatigue. She has felt this way for years and states that along with the pain and fatigue she has alternating episodes of constipation and diarrhea. She has hx of migraines. Physical exam is remarkable only for tenderness to palpation at many points across her body. Lab tests show a normal complete CBC, ESR, CRP and creatinine phosphokinase. Muscle biopsy and electromyography are normal

 Fibromyalgia syndrome Polymyalgia rheumaticainflammatory (abnormal lab values w signs of inflamm), associated w giant cell arteritis, pain symmmetric @ m. of the hip and shoulder girdle

 A 47 year old man presents w 24 hrs of an excruciatingly painful right knee. He had been to a banquet the night before and woke up w a red, swollen knee. He tried taking aspirin, but his pain only worsened. He has a hx of HTN treated w hydrochlorothiazide, and his BMI is 32. On exam, the right knee is warm, erythematous, swollen, and tender to touch. He is afebrile, but the remainder of his exam is unremarkable. You aspirate cloudy yellow fluid from the jt and find 24,000 WBC, 70% PMNs, and needle-shaped crystals that are strongly negatively birefringent.

 Gouty arthritis, an inflammatory arthritis caused by intra-articular deposition of uric acid crystals, either underexcretion/overproduction of uric acid
Acute gout: sudden onset Chronic tophaceous gout: multiple local accumulations of sodium urate in the jts, gradual development, stiffness