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



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