ARTICULAR VS NON-ARTICULAR

• Articular = synovium, synovial fluid, articular cartilage, intraarticular ligaments, joint

capsule, and juxtaarticular bone.
• Nonarticular (or periarticular) = extraarticular ligaments, tendons, bursae, muscle,
fascia, bone, nerve, and overlying skin
Articular vs Periarticular
Articular pain = the joint capsule is diffusely involved; thus:
• pain is often deep/diffuse
• associated with a global decreased range of active and
passive motion in all planes.

Periarticular pain =
• may have point tenderness in the surrounding soft tissue,
• pain occurs only with active (not passive/assisted) range
of motion in a few planes.
Arthritis vs Arthralgia
Arthralgia (joint pain)

Arthritis = Inflammatory process

• Synovitis  warmth, erythema, tenderness to palpation, & synovial
effusion (joint swelling)
• ROM, muscle strength, and function may be limited around the inflamed
joint.
• In an effort to reduce joint volume and pain, the patient often will
involuntarily hold the joint in a position of partial flexion.
• Hence, joint contractures may indicate an underlying inflammatory
process (present or past).
Gout pain =
- begins in the middle of the night
- pricking sensation in the great toe
- quickly escalates into an
intolerable persistent burning pain
Morning Stiffness vs Gel Phenomenon
Morning stiffness (an inflammatory finding)
• Time to maximal improvement after an extended period of inactivity
(an overnight rest),
• Typically improves with movement.
• The duration of morning stiffness is typically greater than 60 min.
• These symptoms closely follow the circadian rhythm of the pro-
inflammatory cytokine, IL-6. Nocturnal anti-inflammatory cortisol
secretion is insufficient to suppress ongoing inflammation.

“Gel” phenomenon (a degenerative feature)

• Short-lived stiffness that is brought on by short periods of rest
• It is common to patients with degenerative arthritis.
Acute Monoarthritis
Acute Monoarthritis
 Gonococcal arthritis

hereditary
hemochromatosis

Undifferentiated polyarthritis
Pattern recognition in rheumatic
disorders
These questions can be answered from synthesis of data 
from the history and physical examination:
• From the history = mode of onset, sequence of 
development of the different features, and the duration 
and pattern of the symptoms
• From the physical examination = the number, distribution, 
and pattern  of the affected joints or periarticular 
structures and the nature of any systemic involvement