Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To differentiate between inflammatory and non-inflammatory joint pain in adults, key clinical features include the pattern of pain, presence of specific signs, and associated systemic symptoms NICE CKS,NICE CKS,NICE NG226,NICE NG219.
- Inflammatory Joint Pain: Inflammatory joint pain often presents with prolonged morning stiffness NICE NG226, and the pain may improve with movement NICE CKS. Symptoms can wake a person during the second half of the night NICE CKS. Clinical signs include synovitis, which manifests as joint swelling, tenderness, or loss of joint function NICE CKS. The affected joint may also be hot and red NICE NG226,NICE NG219. Inflammatory conditions can affect small joints of the hands or feet, or involve more than one joint NICE CKS,NICE NG100. There may be general fatigue NICE CKS and increased inflammatory markers, such as C-reactive protein NICE CKS. Specific features like dactylitis (swelling of a whole digit) or enthesitis (inflammation where tendons or ligaments attach to bone) are strong indicators of inflammatory arthritis, particularly spondyloarthritis NICE CKS. Other associated features can include current or past psoriasis, uveitis, inflammatory bowel disease, or a family history of spondyloarthritis or psoriasis NICE CKS. Gout, a type of inflammatory arthritis, typically presents with a rapid onset (often overnight) of severe pain, redness, and swelling, commonly in the first metatarsophalangeal (MTP) joint, and may involve tophi NICE NG219. Pain from inflammatory conditions may improve within 48 hours of taking a nonsteroidal anti-inflammatory drug (NSAID), and non-NSAID analgesics will not control the inflammation NICE CKS.
- Non-Inflammatory Joint Pain (e.g., Osteoarthritis): In contrast, non-inflammatory joint pain, such as that seen in typical osteoarthritis, generally does not involve prolonged morning joint-related stiffness NICE NG226. The affected joint is typically not hot or swollen NICE NG226. Rapid worsening of symptoms or deformity, or a history of recent trauma, are considered atypical features for osteoarthritis, suggesting other potential causes NICE NG226.