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A 66 year old woman complains of pain in her knees which has come on slowly. The pain is made worse by walking and is relieved by rest. Her knees usually are quite stiff in the mornings, but the stiffness rarely lasts more than 15 minutes. She smokes 10 cigarettes a day and her body mass index is 31. What is the most likely diagnosis?
a : Osteoarthritis Osteoarthritis often affects the knees. It is typically relieved by rest. Prolonged resting, eg following a night’s sleep, can promote the onset of stiffness in the joints which lasts no more than 30 minutes on being active. b : Rheumatoid arthritis Rheumatoid arthritis can affect the knees, but it typically affects the small joints. Early morning stiffness usually lasts longer than 30 minutes in patients with rheumatoid arthritis. Often systemic symptoms (for example, malaise) are present in patients with rheumatoid arthritis. c : Septic arthritis The onset of septic arthritis is usually subacute with maximum intensity of symptoms often achieved after several days. It typically causes a monoarthritis. d : Gout
This clinical picture does not suggest gout. Learning bite: diagnosisDiagnose osteoarthritis clinically without investigations if a person:
Be aware that atypical features, such as a history of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot swollen joint, may indicate alternative or additional diagnoses. Important differential diagnoses include gout, other inflammatory arthritides (for example, rheumatoid arthritis), septic arthritis, and malignancy (bone pain). Beh?et's syndrome typically causes:
Psoriatic arthritis can take a number of different forms - one form is quite similar to the appearance of osteoarthritis. Nail pitting and a rash are suggestive.
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