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Comparison and Summary of Types of Arthritis
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Disease
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Location
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Examination
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Presentation
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Epidemiology
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Aetiology
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Investigations
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Treatment
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Hands, Hips, Knees
Poly/ oligo /
monoarthritis
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Pain on joint movement, reduced range of movements. ‘Squaring of the hand’ – deformity of the CMC joint of the thumb
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Gradual onset (over years), gradual increase in main and reduction in function
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Unusual under 60. Age-related degeneration. Can be secondary to joint damage – e.g. trauma, RA
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Increased incidence in sportsmen/women, trauma increases the risk at the affected joint
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X-ray! Will show joint space narrowing, sclerosis of bone margins, cyst formation, osteophyte formation
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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
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Hands, shoulders, feet, sometimes knees
Polyarthritis
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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
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Very variable. Some may come on acutely overnight, others over several weeks or months. Often the first signs in the feet (walking on marbles)
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More common in women. Can be any age, most commonly 30-50. 2x as common in women.
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Genetic factors involved. Some genes identified (HLA-DL1 &4) – associated with worse prognosis.
Smoking, stress, infection.
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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
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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.
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Hands, Feet
Monoarthritis
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Gouty tophi (chronic gout), hot, red, tender, swollen joint.
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Acute – episodes last up to 7 days. Hot, red, tender, swollen joint
Chronic –presents with gouty tophi.
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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.
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Anything that increases the level of purines or urates in the blood – e.g. high rate of cell death –chemotherapy!
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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
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Acute – use NSAID’s to relieve acute attack, then start on allopurinol.
Chronic –
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