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1. Rheumatoid arthritis
2. Septic arthritis
3. Gouty arthritis
Dasheni Puvanaendran
Gomalah Ganeswaran
Kahmini Manoharan
Rheumatoid arthritis
Points in favour
Points against
50 years old woman
Pain more in the
evening, decreases
on rest
Swellings on the
distal
interphalangeal
joints of the fingers.
Typical feature:
30-40 years old
women
Symptom more in the
morning (morning
stiffness), subsides
throughout the day
swelling at proximal
interphalangeal joint
of fingers
Varus deformity of
the knees
Synovial fluid
analysis: noninflammatory
picture
X-ray: Typical
changes of OA of
the knees
Valgus knee
Chronic
inflammatory
disease
DIFFERENTIAL DIAGNOSIS
SEPTIC ARTHRITIS
POINTS IN FAVOUR
POINTS AGAINST IT
Points in favor:
Points against:
Osteoarthritis
Age of onset:
Over 60 years old
Gout
usually over 30 years
of age in men and
after menopause in
females
Male: female
1:1
Commonly affecting
knee joint(weightbearing)
-large joint involved
Male: female
20:1
Commonly affecting
metatarso-phalangeal
joint of great toe
-small joint involved
Osteoarthritis
Pain is aggravated by
standing, walking,
squatting
Gout
No particular aggravating
factors
May be aggravated by
minor local trauma,
Operation, intercurrent
illness, unaccustomed
exercise, alcohol
consumption
Swelling due to
inflammatory response
Swelling without
discharge
Osteoarthritis
McMurray's test +ve
(traumatic)
Gout
McMurray's test ve
(non-traumatic)
Synovial fluid analysis - Synovial fluid analysis non-inflammatory picture inflammatory picture,
urate crystals seen
X-ray: sub-articular cyst
and bone destruction