Many pathways provoke acute joint complaints: degradation and degeneration of articular cartilage (osteoarthritis), deposition of immune complexes or immune-system-related phenomena (rheumatoid arthritis, rheumatic fever, and gonococcal arthritis), crystal-induced inflammation (gout and pseudogout), seronegative spondylarthropathies (ankylosing spondylitis and Reiter's syndrome), and bacterial invasion (septic or Lyme arthritis) or viral invasion (viral arthritis). These processes impact joint capsules and surfaces, resulting in a cascade of reactive and inflammatory events.
The most useful tool for evaluation of joint disorders is evaluation of synovial fluid. Iable278:1 lists the diagnostic characteristics of synovial fluid. However, joint aspiration may be difficult or impossible in smaller joints or those with minimal effusions. Identifying the distribution and number of affected joints is also necessary for diagnosis (Iablelll2l78-2). A migratory pattern of joint involvement may be helpful as well (TaMe^I,").1,2
TABLE 278-1 Examination of Synovial Fluid
TABLE 278-2 Classification of Arthritis by Number of Affected Joints
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