DipMSK Revision Guide · Chapter 13 of 18

Inflammatory Conditions

RA, spondyloarthritis, connective tissue disease, vasculitis and septic arthritis.

Syllabus: Inflammatory Conditions

Written by Dr David Palethorpe, MBBS, BSc (Hons), MRCGP · NHS GP PartnerReviewed 14 September 202618 min readChapter 13 of 18

Before you start

Try this first

You are trying to separate inflammatory from mechanical joint pain. Which single symptom do you time, and what is the cut-off?

Early morning stiffness. Thirty minutes or less with pain worse on use is mechanical; beyond 30 minutes, easing through the day, is inflammatory.

2 more warm-up questions in the full chapter.

What this chapter covers

  • 13.1Inflammatory versus mechanical joint painStiffness is the discriminator, and you must time it. Thirty minutes or less with pain worse on use is mechanical; beyon…Preview below
  • 13.2Rheumatoid arthritis in primary careMembers
  • 13.3Spondyloarthritis — axial and peripheralMembers
  • 13.4Connective tissue disease and vasculitisMembers
  • 13.5Septic arthritis and the infective mimicsMembers
  • 13.6Community care — comorbidity, DMARD shared care and flaresMembers
  • —Referral, by timeframeRed flags below

Inflammatory versus mechanical joint pain

Core Lens — the takeaway

Stiffness is the discriminator, and you must time it. Thirty minutes or less with pain worse on use is mechanical; beyond 30 minutes, easing through the day, is inflammatory.

Recognise

  • Early morning stiffness lasting more than 30 minutes, often an hour or more, returning after any period of inactivity.
  • Symptoms improve with activity and worsen with rest — the exact reverse of osteoarthritis.
  • Soft, boggy, warm synovial swelling, usually symmetrical at metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints, sparing the distal interphalangeal joints.

The rest of this chapter is in the DipMSK guide

5 more topics, every section opened up, the recall questions and the guidance summaries — written and reviewed by practising UK doctors.

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Referral, by timeframe

Same day · Emergency
  • Any acutely hot, swollen, painful joint with global restriction — whether or not there is fever
  • A single hot swollen joint, or sepsis in anyone immunosuppressed
  • Suspected infected prosthetic joint, or spinal pain with fever and worsening neurology
  • One hot swollen joint, or fever with neutropenia, on a DMARD or biologic
  • Suspected giant cell arteritis, especially with visual symptoms, or vasculitis with haemoptysis
  • Acute anterior uveitis — a painful red eye with photophobia and blurred vision
  • Cytopenia, unexplained transaminase rise, new breathlessness or febrile illness on a DMARD

Also in the full chapter: Urgent · Routine.

← Chapter 12Osteoarthritis (all regions)

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