Differential Diagnosis

1. Rheumatoid arthritis
2. Septic arthritis
3. Gouty arthritis
Dasheni Puvanaendran
Gomalah Ganeswaran
Kahmini Manoharan

Rheumatoid arthritis

Points in favour

Pain in the knees

Bilateral knee swelling
Patella tap positive
Limited range of movement

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

Symptoms pain, swelling

Joint involved knees, IPJ
Joint deformity varus deformity
General examination swellings of
IPJ, varus deformity
Local- fixed flexion deformity,
bilateral ROM decreased
Special tests patella tap positive

POINTS AGAINST IT

AGE 50years old

Symptom very weak
Duration usually present with acute onset
Joints involved usually monoarthritis
Past history history of trauma or infection
Examination local warmth and tenderness
Special test- Mc Murray test positive
Investigation non inflammatory synovial
fluid analysis, typical OA changes

Differential diagnosis of OA:

Gout

Points in favor:

Pain at affected joint

Pain relieved by resting
Pain attack in the evening
Swelling at affected joint
Joint deformity
Restricted activities of daily living
Patella tap +ve at affected joint
Typical OA changes (chronic gout
could lead to secondary OA)

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 effusion

Swelling due to
inflammatory response

Swelling without
discharge

Tophi can ulcerate

through skin and
discharge chalky material

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

X-ray: tophi appears as

punched out cyst or
deep erosion in paraarticular bone end