4/10/2014 Comparison and Summary of Types of Arthritis

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Disease Location Examination Presentation Epidemiology Aetiology Investigations Treatment Osteoarthritis

Hands, Hips,Knees Poly/ oligo / monoarthritis

Pain on jointmovement,reducedrange ofmovements.‘Squaring ofthe hand’ –deformity ofthe CMC jointof the thumb

Gradual onset(over years),gradualincrease inmain andreduction infunction

Unusual under60. Age-relateddegeneration.Can besecondary tojoint damage –e.g. trauma, RA

Increasedincidence insportsmen/women,trauma increasesthe risk at theaffected joint

X-ray! Will showjoint spacenarrowing,sclerosis of bonemargins, cystformation,osteophyteformation

Conservative:analgesia,physiotherapyand encourageexercise (this willnot cause furtherjoint damage) Surgical: in laterstages of thedisease, jointreplacementgreatly relievespain andimprovesfunction. Highlyeffective

RheumatoidArthritis

Hands,shoulders,feet,sometimesknees Polyarthritis

Usually mostapparent atthe hands.Deformities(subluxation,swan necking,z-thumb,nodules etc).Nodulescommon onthe forearm,especially atpressurepoints. Lookfor signs ofsteroid use

Very variable.Some maycome onacutelyovernight,others overseveral weeksor months.Often the firstsigns in thefeet (walkingon marbles)

More commonin women. Canbe any age,most commonly30-50. 2x ascommon inwomen.

Genetic factorsinvolved. Somegenes identified(HLA-DL1 &4) –associated withworse prognosis.Smoking, stress,infection.

Rheumatoid factor– only present in50% of cases. Anti-CCP - morespecific.Blood tests – mayshow anaemia,ESR and CRPraised.Diagnosis usuallyclinical, imagingnot widely used

Steroids – canbe used toinduce remissionin acute disease.Sometimes givenlong-term, lowdose.DMARD’s –diseasemodifying anti-rheumatiddrugse.g.methotrexate,sulfasalazine,hydrochlorequine– reduceirreversible jointdamage. Mostrequire regularblood monitoring.Anti-TNF-α –highly effective,given IV, reduceddiseaseprogression, andimprovessymptoms. VERYEXPENSIVE –NICE onlyrecommends it tobe used whenDMARD’s havefailed.

Gout

Hands, Feet Monoarthritis

Gouty tophi(chronic gout),hot, red,tender,swollen joint.

Acute –episodes lastup to 7 days.Hot, red,tender,swollen jointChronic –

Much morecommon in men(10:1). Somecases aregeneticallyinherited (X-linked), most

Associated with adiet high inpurines (meat)andalcohol.Thiazidediuretics greatly

Aspiratie joint –rule out infection,check for crystals(needle shaped,negativelybirefringent)Serum urate –

Acute – useNSAID’s torelieve acuteattack, then starton allopurinol.Chronic –

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Comparison and Summary of Types of Arthritis

4/10/2014 Comparison and Summary of Types of Arthritis

http://almostadoctor.co.uk/print/content/systems/orthopaedics-and-rheumatology/arthritis/comparison-and-summary-types-arthritis 2/2

presents withgouty tophi.

cases have ageneticcomponent.Age related –urate acidlevels rise withage.

increase the risk.Anything thatincreases thelevel of purines orurates in theblood – e.g. highrate of cell death –chemotherapy!

raised in 60% (notdiagnostic), Infmarkers ↑, x-ray –may show punchedout erosnions, andfleckedcalcifications

allopurinol is thetreatment ofchoice.Dont giveallopurinol in anacute attack! – itcan make itworse!Allopurinol willnot relieve anacute attack

Pseudogout

Knee, hands,elbows,shoulder,Tarsal joints Monoarthritis

Hot, red,tender,swollen joint.

Acute – hot,red, tenderswollen joints.Chronic – canresemble RA,or OA. Ofteninterspersedwith acuteepdisodes

Increases withage. OftenaccompaniesOA

Phosphatemetabolismdisorders

Aspiratie joint –rule out infection,check for crystals(rhomboid,positivelybirefringent)

NSAID’s not asuseful as gout,but may still bebeneficial forsome.Intra-articularsteroidinjections, ororal steroids areusually the firstline. No real‘allopurinol’equivalent

SystemicSclerosis

Systemicmulti-organinvolvement,(often lungsandoesophagus)usually withhand signs

Hands andarms: pigmentchanges,telangiectasia,sclerodactyly,digital pitting,Reynaud’s,

Any age, mostcommonly 30-50. 4x ascommon inwomen

Genetic factors

SLE

Systemic.Typicallyphotosensitiveskin rashes(often on theface), andorganinvolvement(mostcommonlykidneys)

May havehand signssimilar o RA –but thedeformitieswill reduceunderpressure, andfunction isusually notaffected. Lookfor rash onface, arms,chest andshoulders

Often lots ofnon-specificsymptoms –low-gradefever,tiredness,generalmalaise. Mayalso havemulti-organinvolvement.Mouth ulcers,hair loss,Reynaud’s,depression

10x as commonin women. Anyage, oftenbetween 25-35,and between 5-60

Smoking, stress.Genetic factors

ANA’s – present in90% of cases butnon-specific. Anti-dsDNA – present in60% of cases, andspecific. Anaemia,leukopenia,thrombocytopaenia.↑ESR and CRP

DMARD’s andsteroids used ina similar way toRA. Treat organand nerologicalinvolvementsspecifically andindividually.

If a joint is hot, red, tender and swollen – then always aspirate it! – and it is joint sepsis, until proven otherwise

Copyright 2009 - 2013 - Dr Tom Leach

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