Symptoms
 

Joint Stiffness

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Overview

  • Joint stiffness is often accompanied by pain, and may be caused by inflammatory or non-inflammatory arthropathies. The clinical history can be used to delineate between these two major causes of arthropathy.

Aetiology

    • Causes of Joint Stiffness

    • 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
    • Loose intra-articular body
    • Tendinitis
    • Bursitis

History of Presenting Complaint

    • Distribution

      Number of joints affected, whether the stiffness 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 stiffness began suddenly or gradually, and in what situation.
    • Onset post traumaSuggestive of fracture, dislocation or soft tissue injury
    • Onset post recent infectionSuggestive of reactive arthritis
    • Associated Symptoms

      Whether the pain is associated with any other symptoms.
    • Joint pain and swellingNon-specific, may be suggestive of inflammation
    • Numbness / paraesthesiaSuggestive of nerve 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
    • Timing

      How long the stiffness has been going on for and whether it is worse at any specific time of day.
    • Morning stiffnessSuggestive of inflammatory cause
    • Intermittent ‘locking’ of the jointSuggestive of mechanical issue e.g. intraarticular foreign body
    • Exacerbating Factors

      Whether there is anything that makes the stiffness worse, such as exercise or prolonged rest.
    • Exacerbated with activitySuggestive of non-inflammatory cause e.g. osteoarthritis
    • Alleviating Factors

      Whether there is anything that relieves the stiffness.
    • Improved with activitySuggestive of inflammatory cause
    • Severity

      How the stiffness if 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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