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MSK History

Joint Swelling



Swelling of one or more joints may be accompanied by joint pain or stiffness. It is important to consider septic arthritis, an imminently life-threatening cause, in any patient with joint swelling, however there are many other inflammatory and non-inflammatory causes.


  • Causes of Joint Swelling

  • Inflammatory

  • Rheumatoid arthritis
  • Seronegative spondyloarthropathies - reactive arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease-related arthritis
  • Crystal arthropathies - gout, pseudogout
  • Vasculitis - Wegener’s, polyarteritis nodosa, giant cell arteritis
  • Systemic inflammation - SLE, polymyositis, dermatomyositis
  • Septic arthritis - gonococcal, Staph, Strep, gram negative
  • Other infection - TB, Lyme disease
  • Sarcoidosis
  • Degenerative

  • Osteoarthritis
  • Traumatic

  • Fracture
  • Dislocation
  • Soft tissue injury - menisceal tear, ligamentous tear
  • Haemarthrosis (traumatic or in the setting of coagulopathy)
  • Other

  • Malignancy - sarcoma, metastasis
  • Avascular necrosis
  • Tendonitis
  • Bursitis

Differential Diagnosis

  • Differential Diagnosis of Limb Swelling

  • Commonly Unilateral

  • Trauma - fracture, muscle sprain or rupture, compartment syndrome
  • Tenosynovitis
  • Skin / soft tissue infection - cellulitis, abscess, osteomyelitis
  • Venous - DVT, superficial thrombophlebitis, venous insufficiency
  • Lymphoedema
  • Commonly Bilateral / Generalised

  • Volume overload - heart failure, cirrhosis, nephrotic syndrome
  • Lymphoedema
  • Medications - NSAIDs, calcium channel blockers, beta blockers, alpha blockers, aciclovir, cyclophosphamide, cyclosporine, corticosteroids, oestrogen, progesterone
  • Hypoalbuminaemia - malnutrition, malabsorption, nephrotic syndrome, liver (synthetic) failure
  • Pretibial myxoedema (profound hypothyroidism)

History of Presenting Complaint

  • Distribution

    Number of joints affected, whether the swelling is symmetrical or asymmetrical and whether large or small joints are affected.
  • Monoarthropathy: one joint affectedNon-specific; most causes can (initially)present with monoarthropathy
  • Polyarthropathy: multiple joints affectedMore likely to represent an inflammatory cause
  • Symmetrical small-joint involvementSuggestive of rheumatoid arthritis
  • Affecting large joints of the lower limbSuggestive of osteoarthritis or reactive arthritis
  • Pain, swelling and warmth in the great toeClassical presentation of acute gout
  • Onset

    Whether the swelling began suddenly or gradually, and in what situation.
  • Sudden onset knee pain and swellingSuggestive of haemarthrosis
  • Onset post traumaSuggestive of fracture, dislocation or soft tissue injury
  • Onset post recent infectionSuggestive of reactive arthritis
  • Timing

  • How long the swelling has been going on for.
  • Associated Symptoms

    Whether the swelling is associated with any other symptoms.
  • PainNon-specific; swelling is often associated with pain
  • FeversSuggestive of septic arthritis or inflammatory cause
  • Eye pain / conjunctivitisSuggestive of reactive arthritis
  • DysuriaSuggestive of reactive arthritis
  • Dry eyes / mouthSuggestive of Sjogren’s syndrome
  • RashPotential SLE or psoriatic arthritis
  • Severity

    How the swelling is functionally affecting the patient.
  • Hand - buttons, keys, taps, shopping bags, dressing, showering, eating
  • Wrist - dressing, toilet, eating
  • Elbow -  dressing, lifting objects
  • Shoulder - dressing, top shelves, hanging washing, lifting objects
  • Back -  walking, shoes, stairs, hills, lifting
  • Hip - walking, getting in/out of cars, stairs
  • Knee - chairs, shoes, stairs, kneeling, getting in/out of cars
  • Ankle - walking
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