Distinguishing between Inflammatory and Degenerative joint disease Inflammatory Joint Disease • Swelling stimulates joint nociceptors -> Pain with rest • Overnight fluid accumulation in the synovial membrane -> Morning stiffness • Moving the joint physically pushes fluid back into lymphatics, relieving the painful swelling -> Pain relieved with motion • Lots of fluid, takes more time (hours) to be reabsorbed by lymphatics -> Stiffness resolves after > 1 hr • Blood carries heat and looks red -> Warm Red Swollen Joints • Inflammation is oftentimes systemic, not localized exclusively within the joint (i.e. in Rheumatoid arthritis, Lupus, etc) -> Extra-articular manifestations; positive inflammatory markers (CRP, ESR, RF, ANA) Degenerative Joint Disease • Motion (using the joint) exacerbates the mechanical forces that are wearing down the joint -> Pain with motion (relieved by rest) • Fragments of broken articular cartilage triggers a mild synovial inflammation that seeps fluid into the synovial membrane during inactivity -> Joint stiffness after inactivity • Larger, weight-bearing joints tend to bear the brunt of the mechanical forces -> Most commonly affects the knee hip and L/C-spine facet ioints • Moving the joint physically pushes inflammatory fluid back into lymphatics within minute -> Stiffness is short-lived, quickly relieved by movement #Inflammatory #Degenerative #Comparison #Versus #MSK #JointDisease #JointPain #Diagnosis #pathophysiology
