Arthritis - Comparison and Summary of Types of Arthritis

Comparison and Summary of Types of Arthritis

Hands, Hips, Knees
Poly/ oligo /
Pain on joint movement, reduced range of movements. ‘Squaring of the hand’ – deformity of the CMC joint of the thumb
Gradual onset (over years), gradual increase in main and reduction in function
Unusual under 60. Age-related degeneration. Can be secondary to joint damage – e.g. trauma, RA
Increased incidence in sportsmen/women, trauma increases the risk at the affected joint
X-ray! Will show joint space narrowing, sclerosis of bone margins, cyst formation, osteophyte formation
Conservative: analgesia, physiotherapy and encourage exercise (this will notcause further joint damage)
Surgical: in later stages of the disease,joint replacement greatly relieves pain and improves function. Highly effective
Hands, shoulders, feet, sometimes knees
Usually most apparent at the hands. Deformities (subluxation, swan necking, z-thumb, nodules etc). Nodules common on the forearm, especially at pressure points.Look for signs of steroid use
Very variable. Some may come on acutely overnight, others over several weeks or months. Often the first signs in the feet (walking on marbles)
More common in women. Can be any age, most commonly 30-50. 2x as common in women.
Genetic factors involved. Some genes identified (HLA-DL1 &4) – associated with worse prognosis.
Smoking, stress, infection.
Rheumatoid factor – only present in 50% of cases. Anti-CCP -more specific.
Blood tests – may show anaemia, ESR and CRP raised.
Diagnosis usually clinical, imaging not widely used
Steroids – can be used to induce remission in acute disease. Sometimes given long-term, low dose.
DMARD’s – disease modifying anti-rheumatid drugse.g. methotrexate, sulfasalazine, hydrochlorequine –reduce irreversible joint damage. Most require regular blood monitoring. Anti-TNF-α – highly effective, given IV, reduced disease progression, and improves symptoms. VERY EXPENSIVE –NICE only recommends it to be used when DMARD’s have failed.
Hands, Feet
Gouty tophi (chronic gout), hot, red, tender, swollen joint.
Acute – episodes last up to 7 days. Hot, red, tender, swollen joint
Chronic –presents with gouty tophi.
Much more common in men (10:1). Some cases are genetically inherited (X-linked), most cases have a genetic component.
Age related – urate acid levels rise with age.
Associated with adiet high in purines(meat) andalcohol.Thiazidediuretics greatly increase the risk.
Anything that increases the level of purines or urates in the blood – e.g. high rate of cell death –chemotherapy
Aspiratie joint – rule out infection, check for crystals (needle shaped, negatively birefringent)
Serum urate – raised in 60% (not diagnostic), Inf markers , x-ray –may show punched out erosnions, and flecked calcifications
Acute – use NSAID’s to relieve acute attack, then start on allopurinol.
Chronic –  $(function(){ var pertama = $('#herb-dict .herblist li:first-child').attr('class'); $('#herb-dict .herblist li.'+pertama).show(); $('#herb-dict .alphlist li#'+pertama+' a').addClass('active'); $('#herb-dict .alphlist li a').click(function(){ var target = $(this).attr('rel') $('#herb-dict .herblist li').hide(); $('#herb-dict .herblist li.'+target).show(); $('#herb-dict .alphlist li a').removeClass('active'); $(this).addClass('active'); }); });