🦴 Chronic joint pain and stiffness is a common presentation in both primary care and rheumatology clinics. 👉 It can result from mechanical wear-and-tear, systemic inflammatory diseases, infection, or metabolic/autoimmune causes. The challenge is distinguishing inflammatory vs non-inflammatory pathology, as this guides investigations and management.

📖 About

• Chronic joint pain: Pain lasting >6 weeks, may be constant or intermittent.
• Stiffness: Inflammatory conditions → prolonged morning stiffness (>30 min). Mechanical conditions → brief stiffness (<30 min), worse with activity.
• Important to assess joint distribution (small vs large joints, symmetrical vs asymmetrical).

⚡ Causes of Chronic Joint Pain & Stiffness

• Degenerative (Mechanical):
  • Osteoarthritis (OA) – most common; worse with use, improves with rest.
  • Previous trauma or joint injury.
• Inflammatory:
  • Rheumatoid arthritis (RA) – symmetrical small joint pain, morning stiffness >1 hr, systemic features.
  • Spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis, reactive arthritis).
  • Crystal arthropathies (gout, CPPD/pseudogout).
• Infective: Chronic septic arthritis (TB arthritis, Lyme disease).
• Metabolic/Endocrine: Haemochromatosis, acromegaly, thyroid disease.
• Other systemic causes: Lupus, connective tissue diseases.

🩺 Clinical Features

• History: Onset, duration, pattern, morning stiffness, effect of activity, systemic symptoms (fatigue, fever, rash, weight loss).
• Exam:
  • Joint swelling, warmth, effusion.
  • Deformities (ulnar deviation in RA, Heberden’s nodes in OA).
  • Reduced range of motion and functional limitation.
  • Check for extra-articular features (skin, eyes, nails, spine).

🔎 Investigations

• Bloods: FBC, ESR, CRP, U&E, LFTs.
• Autoantibodies: RF, anti-CCP (RA); ANA, dsDNA (SLE); HLA-B27 (spondyloarthritis).
• Joint aspiration: Microscopy & culture (exclude infection, crystals).
• Imaging:
  • X-ray: OA → joint space narrowing, osteophytes. RA → periarticular osteopenia, erosions.
  • MRI: Early synovitis or sacroiliitis.
  • US: Synovial thickening, effusions, power Doppler activity.

📝 Comparison of Common Chronic Joint Disorders

💊 Management Principles

• General measures: Weight loss, physiotherapy, exercise programmes, joint protection advice.
• Analgesia: Paracetamol, NSAIDs (use with PPI cover), topical agents.
• Disease-specific:
  • OA → conservative + joint injections; arthroplasty if severe.
  • RA & inflammatory arthritis → DMARDs (methotrexate, sulfasalazine, leflunomide), biologics (anti-TNF, anti-IL-6).
  • Gout → acute: NSAIDs/colchicine/steroids; long-term urate-lowering therapy (allopurinol, febuxostat).
  • Spondyloarthropathies → physiotherapy, NSAIDs, biologics if severe.
• Multidisciplinary care: Rheumatology referral, orthopaedics, pain clinics, occupational therapy.

🚩 Red Flags

• Rapidly progressive monoarthritis → suspect septic arthritis or crystal disease.
• Systemic features (fever, weight loss, night sweats) → possible infection or malignancy.
• Back pain + neurological deficit → urgent spinal assessment.
• Unexplained chronic pain with constitutional symptoms → consider TB, endocarditis, malignancy.

📚 Exam Pearls

• Morning stiffness >1 hr → inflammatory arthritis (RA, spondyloarthropathy).
• Stiffness <30 min, worse on activity → OA.
• Asymmetrical oligoarthritis in young male → reactive or psoriatic arthritis.
• Always aspirate acutely swollen joint before giving steroids.