Differential diagnosis of oedema and arthritis of the hands
| Diagnosis | Clinical features | Investigations |
|---|---|---|
| RS3PE syndrome | Elderly male. Exquisite response to low dose corticosteroids. Long term remission after withdrawal | Negative RF and ANA. No erosion on radiography |
| Mixed connective tissue disease (Sharp syndrome) | Young female Raynaud phenomena | High titre speckled ANA (U1-RNP specificity) |
| CPPD disease (chondrocalcinosis) | Elderly patient, female predominance. Often asymmetric, absence of constitutional symptoms. Good clinical response to NSAIDs | Chondrocalcinosis on hands, knee and pelvic radiography. Crystal demonstration by synovial fluid analysis with polarised light |
| Reflex sympathic dystrophy (Sudeck’s disease, algodystrophy) | Exquisitely painful oedema, vasomotor and skin alterations. Absence of true arthritis, presence of predisposing factors | Absence of systemic inflammation. Radiological exams (standard radiographs, bone scintigram and RMI) |
| Amyloid arthropathy | Rare disease, firm and non-inflammatory pseudo-oedema Frequent nodules and carpal tunnel syndrome. Slow and insidious onset and no morning stiffness. Polyvisceral involvement | Proteinuria, monoclonal gammapathy or light chain in urine (AL type). Demonstration on free amyloid debris in synovial fluid and/or specific birefregence with Congo Red staining on biopsies |
| Reiter’s or psoriatic spondylarthropathy | Cutaneous, axial, ocular or urogenital signs and symptoms. Mostly asymmetrical, sausage fingers Occasionally firm and non-pitting lymphoedema | HLA-B27 positive. Sacroiliitis on radiography |
| Late onset spondylarthropathy | Asymmetrical pitting oedema of lower limbs with oligoarthritis. Middle aged men. Severe constitutional symptoms. Poor response to corticosteroids | HLA-B27 positive. No axial disease |
| Rheumatoid arthritis | Female predominance, symmetrical synovitis of MCPs and IPs. Good but not dramatic response to corticosteroids | RF, erosions on radiography |
| Polymyalgia rheumatica | Elderly patient (female predominance 1.5–2 :1). Rare true peripheral synovitis, usually mild. Dramatic response to corticosteroids but long duration of treatment and frequent flares | Temporal artery biopsy |