Joint symptoms

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Muscle stiffness or pain
Usually worse in the early morning often with pain and stiffness.

Your GP will consider the following differential diagnoses:
Normal response to strenuous exercise
 Suggested by: fit healthy, unaccustomed exercise 1 to 2 days before.
Confirmed by: spontaneous resolution.
Polymyalgia rheumatica Suggested by: onset over weeks or months, stiff, painful, and tender proximal muscles. Fatigue, fever in elderly person.
Confirmed by: elevated ESR. Rheumatoid factor -ve, prompt response to prednisolone, no other cause (e.g. infection on follow-up).
Management: See your GP
Rheumatoid arthritis Suggested by: early morning stiffness. Fingers showing swan neck or boutonnireâ deformities. Thumbs show Z-deformities. MCP joints and wrists are sublux giving ulnar deviation.
Knees: valgus or varus deformity and popliteal Baker's cysts.
Feet: subluxation of meta-tarsal heads with hallux valgus, clawed toes.
Confirmed by: rheumatoid factor +ve, anti-IgG autoantibody.
FBC: Normochromic anaemia,  Elevated ESR when active.

Ankylosing spondylitis Suggested by: onset over months or years. Stiffness and progressive loss of spinal movement. Kyphosis and spinal extension.
Confirmed by: bamboo spine on back X-ray and loss of sacroileal joint space. Rheumatoid factor -ve, HLA-B27 +ve.

Primary muscle disease Suggested by: onset over weeks to years. Predominant weakness.
Confirmed by: CPK, electromyography and muscle biopsy.

Primary hypothyroidism Suggested by: onset over weeks to months. Predominant fatigue. Also cold intolerance, depression.
Confirmed by: TSH, FT4.

Early manifestation of occult malignancy Suggested by: onset over weeks or months. Weight loss, anorexia.
Confirmed by: subsequent appearance of malignancy, especially spinal secondary deposits.
Fibromyalgia Suggested by: variable onset -weeks to years. Diffuse pain and stiffness but no features of specific diagnosis.
Confirmed by: no subsequent development of features of a specific diagnosis, normal ESR, Rheumatoid factor -ve, CPK normal, TSH & FT4 normal.

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