If the joint is thought to be the pathology causing the symptoms the clinician will have to choose the likely process. Of the three major diagnostic categories one is arthritis of an inflammatory cause, involving the synovial joint linings and the bone-ligament and bone-tendon junctions (the entheses). The function and structure of a joint can be affected by arthritic changes not of an inflammatory nature, secondary to meniscal or articular cartilage hurt or caused by other joint changes which can be from a number of causes.The third possibility is joint pain or arthralgia in the absence of significant pathology, such as fibromyalgia or with sub clinical changes that have yet to declare themselves. Different types of joint disorders can occur in the same joint with inflammatory disorders typically destabilising a joint and leading to structural abnormality. Pain is a significant symptom of these joint disorders and in inflammatory conditions the pain is present whether the joint is moving or still, with it typically being worse as the movement is started. With arthritic changes that are not secondary to inflammation pain occurs typically with movement and improves with resting.If the arthritic changes become very advanced in the spine or major joints patients may suffer pain even when they are resting and also at night. Larger joint pain is less clearly localised to the joint than pain from smaller joints, with hip pain possibly referred to the buttock, lateral thigh, groin or front of thigh. Stiffness is common with arthritis and a hard symptom to define, but it means difficulty moving a joint, especially after a period of resting, which goes off with movement. Inflammatory joint stiffness may last longer, for example half an hour to an hour, while osteoarthritic stiffness may ease after 10-15 minutes.There are several changes which can occur in a joint to make it swell. If the joint is affected by non-inflammatory arthritis then bony growths form at the margins of the joints and the end of the fingers or the knees become knobbly joints. Or an effusion, a collection of fluid within a joint capsule, can form secondary to inflammatory disease and can be drawn off by injecting the joint. It is common for an affected joint to show a degree of loss of movement either because the soft tissues have tightened up, the joint is hurt anatomically or by restriction from pain and inflammation.Getting dressed, looking after oneself and mobility such as walking and stairs are some of the activities of daily living which can be affected by arthritic disease. Loss of bulk and power in the muscles can clarify at least some of functional loss and if pain and weakness occur in a joint then a muscular or neurological pathology is unlikely. Having problems with stable gait, getting up from a chair or the floor and holding things can all be interfered with by the weakness. Feeling unwell and suffering fatigue occurs in systemic arthritic conditions as the whole body is affected. Arthritic symptoms can come on slowly or quick, with rapid onset due to infection, crystal arthritis and traumatic events.Rheumatoid arthritis and osteoarthritis, the two most occurring joint diseases, typically come on slowly like many arthritic conditions. The classification of joint involvement is acute if the joint presents problems for less than six weeks, sub-acute if it persists for between six and twelve weeks and chronic if it continues beyond twelve weeks, although this is not rigidly adhered to. Joints exhibit varying patterns of involvement, with one type showing affected joints continuing to be affected whilst new ones develop problems and another type, for instance gout, where sudden bouts of arthritis are punctuated by clear periods without problems.Non-symmetrical and symmetrical joint patterns of involvement can occur. SLE and rheumatoid arthritis tend to affect the same joints on each side of the body in a symmetrical pattern while psoriatic arthritis and reactive arthritis involve different joints on each side of the body, the asymmetrical pattern. Joints may be involved in different patterns also, for example distal finger joints in osteoarthritis and psoriatic arthritis but not in rheumatoid arthritis.
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