Private joint pain clinic in London, same-day physiotherapy.

Inflammatory or mechanical?

• Inflammatory — prolonged morning stiffness, joint swelling and warmth, pain that eases as you move, waking in the second half of the night, fatigue, and a good response to anti-inflammatories. Points to rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, lupus, gout or reactive arthritis.
• Mechanical — brief stiffness, pain worse with activity and better with rest, no swelling or only bony swelling, crepitus. Points to osteoarthritis, tendon problems or injury.

One joint or many?

• One joint, acute — septic arthritis, gout, pseudogout, injury, or the start of an inflammatory arthritis.
• Few joints, asymmetrical — psoriatic arthritis, reactive arthritis, spondyloarthritis.
• Many joints, symmetrical, small joints of hands and feet — rheumatoid arthritis, lupus, viral arthritis.
• Many joints, weight-bearing and hands, over years — osteoarthritis.
• Widespread pain without swelling, with fatigue and poor sleep — fibromyalgia.

What gets tested

• Inflammatory markers — CRP and ESR
• Full blood count, kidney and liver function
• Rheumatoid factor and anti-CCP
• Urate for gout — though it can be normal during an attack
• ANA where lupus or connective tissue disease is suspected
• HLA-B27 where spondyloarthritis is suspected
• Ultrasound, which detects synovitis and effusion far more sensitively than examination alone
• Joint aspiration where infection or crystals need excluding

What helps most conditions