Pain in the morning with improvement as the day progresses is a strong clinical clue for inflammation. This could be an early presentation of any of the inflammatory arthropathies (ie, rheumatoid arthritis, spondyloarthropathies) or polymyalgia rheumatica, which is characterized by a nonspecific synovitis of the hip and shoulder joints. Polymyositis is proximal in distribution but weakness (as reported by the patient as limitation in function as well as weakness as noted on examination) is more prominent than pain. Pain with active supination is suggestive of biceps tendonitis, a condition in which pain is activity-related (rather than inflammatory pain, which peaks after prolonged rest). Cervical spine disease can be manifested by shoulder pain but tends to worsen as the day progresses. Gout is inflammatory, but the pain pattern is acute onset of severe pain, which resolves over a matter of days. Chronic tophaceous gout can resemble rheumatoid arthritis in appearance, but is not typically characterized by stiffness.
- Positive alizarin stain on synovial fluid analysis.
Click here to return to the questions
Seminars in Medical Practice
Hospital Physician Board Review Manuals
Copyright © 2009, Turner White Communications
Updated 1/04/08 kkj