There is no specific test for this condition. Diagnosis is based on signs and symptoms, and exclusion of other conditions. Differential diagnoses *Rheumatoid arthritis. Confusion with rheumatoid arthritis may be common even though IH is a non-inflammatory condition without the many signs and symptoms associated with RA. So far, an association with HLA-B27 gene in IH has not been reported. With RA, small joints are mostly affected in an inflammatory, destructive manner. This is not observed in IH. Rheumatoid factor, cyclic citrullinated peptide antibodies and antinuclear antibodies are usually negative in IH. *Palindromic rheumatism. Like IH, palindromic rheumatism (PR) is also characterised by relapsing, short-episodes of sudden onset arthritis with no recognisable trigger. However, unlike PR, IH affects the knee almost exclusively and there is a predictable periodic, regularity of attacks, with laboratory tests during attacks being generally unremarkable. PR is also more likely to be associated with development of rheumatoid arthritis. *Familial Mediterranean Fever. For some patients with FMF, episodes of knee or joint inflammation may be the only presenting symptom during an acute inflammatory episode. The MEFV gene mutations associated with FMF have been implicated in the pathogenesis of both palindromic rheumatism and IH. *Other conditions for consideration (or exclusion) are other periodic arthropathies, crystal arthopathy, prepatellar bursitis (housemaids knee), pigmented villonodular synovitis, trauma and infectious causes.
Intermittent hydrarthrosis
Neuralgia-inducing cavitational osteonecrosis
Complications of prolonged standing
Progressive osseous heteroplasia
Repetitive strain injury
Microdamage in bone
Articular cartilage damage
Metastatic calcification