DIAGNOSIS CHECKLIST
for Joint swelling

Why: to determine if acute or chronic.

Why: would suggest septic arthritis, gout, tuberculosis, hemophilia, sickle cell disease, trauma and pseudogout.

Why: asymmetrical involvement is more typical of gout, rheumatic fever, hemophilia, bone cancer, septic arthritis and trauma. Symmetrical involvement is more characteristic of rheumatoid arthritis and osteoarthritis.

Why: Involvement of the small joints is characteristic of rheumatoid arthritis, gonococcal arthritis and Reiter's syndrome. Involvement of the larger joints is more characteristic of gout and osteoarthritis. However osteoarthritis and rheumatoid arthritis may involve both.

Why: i.e. joint pain and swelling moves from joint to joint? - may suggest rheumatic fever.

Why: Younger people are most likely to have systemic lupus erythematosus, hemophilia, trauma, rheumatoid arthritis and gonococcal arthritis. Older people are more likely to have osteoarthritis, gout or bone tumor. There is however a significant overlap.

Why: e.g. acute joint swelling (1-4 hours) with intense pain would suggest blood, infection or gout; subacute (1-2 days) soft joint swelling would suggest synovial effusion (fluid); chronic and bony joint swelling would suggest osteoarthritis; chronic and soft/boggy joint swelling would suggest synovial proliferation such as rheumatoid arthritis.

Why: may suggest viral arthritis including influenza, mumps, rubella, varicella, hepatitis A and B, infectious mononucleosis, cytomegalovirus, parvovirus, Ross river virus.

Why: may indicate joint strain, joint sprain, tendonitis or bursitis of the joint or secondary osteoarthritis ( osteoarthritis that follows injury and wear and tear).

Why: may suggest Ross river fever or dengue fever.

Why: systemic diseases that may predispose to or present with joint swelling include systemic lupus erythematosus, bleeding disorders, rheumatic fever, tuberculosis, hepatitis B, diabetes mellitus, Wegener's granulomatosis, HIV infection, hemochromatosis, Paget's disease.

Why: e.g. certain medications may precipitate gout including frusemide and thiazide diuretics; some medications may induce a Lupus syndrome including hydralazine, procainamide, phenytoin, chlorpromazine, isoniazid and methyldopa.

Why: may suggest septic arthritis, hepatitis B or C, HIV-associated joint disease, subacute bacterial endocarditis and serum sickness reactions.

Why: can determine risk of Reiter's syndrome, gonococcal arthritis, Hepatitis B or HIV viral arthritis.

Why: e.g. osteoarthritis, rheumatoid arthritis, gout, pseudogout, hemophilia.

Why: can provide information about the risk of dengue fever.

Why: If have joint swelling without pain, especially on motion, would suggest Charcot's disease (degenerative joint disease due to lack of protective pain sensation. May be associated with neurosyphilis, cauda equina lesion, diabetic neuropathy or syringomyelia).

Why: may suggest septic arthritis, rheumatic fever, gonococcal arthritis, Reiter's syndrome, lupus erythematosus, Lyme arthritis, polymyalgia rheumatica, Still's disease and rheumatoid arthritis.

Why: would suggest Reiter's syndrome or gonococcal arthritis.

Why: would suggest rheumatoid spondylitis, ochronosis or gout.

Why: may suggest enteropathic arthritis (such as due to Ulcerative colitis or Crohn's disease) or Reiter's syndrome.

Why: may suggest psoriatic arthritis, gonococcal arthritis or HIV infection.

Why: may suggest Ankylosing spondylitis, Reiter's disease.

Why: e.g. usually symmetrical and can affect many joints. Pain is worse at the end of the day and aggravated by use and cold weather, relieved by rest. Usually associated with pronounced stiffness, especially after activity.

Why: e.g. usually starts with the gradual onset of pain and stiffness of the small joints of the hands and feet. Joint pain is worse on waking, nocturnal pain with disturbed sleep, pain is relieved with activity. Morning and rest stiffness can last for hours. May be associated with weakness, weight loss, malaise and fatigue.

Why: e.g. often excruciating pain in the great toe starting in the early hours of the morning, skin over the joint may be red, shiny, swollen and hot, joint is very tender to touch. Pain may be precipitated by alcohol excess, surgical operation, starvation and certain medications.

Why: e.g. symmetrical involvement of many joints, mainly of the hands and feet and is usually mild pain. It is caused by many viruses, including those causing influenza, mumps, rubella, varicella, hepatitis A and B, infectious mononucleosis, cytomegalovirus, parvovirus, Ross river virus.

Why: e.g. typically occurs in children and young adults, migratory polyarthritis (many joints are involved, joints affected alter with time), involves large joints sequentially, one becoming hot, red, swollen and very painful as the other subsides. It rarely lasts more than five days in any one joint. Associated with acute fever.

Why: e.g. fatigue, painful joints, impotence, bronze discoloration of skin. Joints involved are characteristically the second or third metacarpophalangeal joints (knuckles of the hand).

Why: e.g. typically occurs in ages 60-70 presenting with pain and stiffness in shoulder, hip and cervical spine; symmetrical distribution; early morning stiffness. May be systemic signs such as weight loss, loss of appetite and fatigue. Painful restriction of movement of shoulders and hips.

Why: e.g. conjunctivitis, urethritis (painful urination, penile discharge, vaginal discharge).

Why: e.g. months or years after a tick bite develop joint pain, usually of the large joints such as knee; typical rash (a dough-nut shaped red rash about 6cm in diameter) at the bite site; heart disorders (especially abnormal rhythms of the heart) or disease of the central nervous system (including weakness of the muscles in the limbs, muscular pain or evidence of meningitis).