4/10/2014

Comparison and Summary of Types of Arthritis

Published on almostadoctor.com - free medical student revision notes (http://almostadoctor.co.uk) Home > Systems > Orthopaedics and Rheumatology > Arthritis > Comparison and Summary of Types of Arthritis

Comparison and Summary of Types of Arthritis

Disease Osteoarthritis Location
Hands, Hips, Knees Poly/ oligo / monoarthritis

Examination
Pain on joint movement, reduced range of movements. Squaring of the hand deformity of the CMC joint of the thumb

Presentation
Gradual onset (over years), gradual increase in main and reduction in function

Epidemiology
Unusual under 60. Age-related degeneration. Can be secondary to joint damage e.g. trauma, RA

Aetiology
Increased incidence in sportsmen/women, trauma increases the risk at the affected joint

Investigations
X-ray! Will show joint space narrowing, sclerosis of bone margins, cyst formation, osteophyte formation

Treatment
Conservative: analgesia, physiotherapy and encourage exercise (this will not cause further joint damage) Surgical: in later stages of the disease, joint replacement greatly relieves pain and improves function. Highly effective Steroids can be used to induce remission in acute disease. Sometimes given long-term, low dose. DMARDs disease modifying antirheumatid drugse.g. methotrexate, sulfasalazine, hydrochlorequine reduce irreversible joint damage. Most require regular blood monitoring. Anti-TNF- highly effective, given IV, reduced disease progression, and improves symptoms. VERY EXPENSIVE NICE only recommends it to be used when DMARDs have failed. Acute use NSAIDs to relieve acute attack, then start on allopurinol. Chronic

Rheumatoid Arthritis

Hands, shoulders, feet, sometimes knees Polyarthritis

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. AntiCCP - more specific. Blood tests may show anaemia, ESR and CRP raised. Diagnosis usually clinical, imaging not widely used

Hands, Feet

Gout
Monoarthritis

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

Acute episodes last up to 7 days. Hot, red, tender, swollen joint Chronic

Much more common in men (10:1). Some cases are genetically inherited (Xlinked), most

Associated with a diet high in purines (meat) and alcohol.Thiazide diuretics greatly

Aspiratie joint rule out infection, check for crystals (needle shaped, negatively birefringent) Serum urate

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

1/2

4/10/2014

Comparison and Summary of Types of Arthritis

presents with gouty tophi. cases have a genetic component. Age related urate acid levels rise with age. increase the risk. Anything that increases the level of purines or urates in the blood e.g. high rate of cell death chemotherapy! raised in 60% (not diagnostic), Inf markers , x-ray may show punched out erosnions, and flecked calcifications allopurinol is the treatment of choice. Dont give allopurinol in an acute attack! it can make it worse! Allopurinol will not relieve an acute attack NSAIDs not as useful as gout, but may still be beneficial for some. Intra-articular steroid injections, or oral steroids are usually the first line. No real allopurinol equivalent

Pseudogout

Knee, hands, elbows, shoulder, Tarsal joints Monoarthritis

Hot, red, tender, swollen joint.

Acute hot, red, tender swollen joints. Chronic can resemble RA, or OA. Often interspersed with acute epdisodes

Increases with age. Often accompanies OA

Phosphate metabolism disorders

Aspiratie joint rule out infection, check for crystals (rhomboid, positively birefringent)

Systemic Sclerosis

SLE

Systemic multi-organ involvement, (often lungs and oesophagus) usually with hand signs Systemic. Typically photosensitive skin rashes (often on the face), and organ involvement (most commonly kidneys)

Hands and arms: pigment changes, telangiectasia, sclerodactyly, digital pitting, Reynauds, May have hand signs similar o RA but the deformities will reduce under pressure, and function is usually not affected. Look for rash on face, arms, chest and shoulders

Any age, most commonly 3050. 4x as common in women

Genetic factors

Often lots of non-specific symptoms low-grade fever, tiredness, general malaise. May also have multi-organ involvement. Mouth ulcers, hair loss, Reynauds, depression

10x as common in women. Any age, often between 25-35, and between 560

Smoking, stress. Genetic factors

ANAs present in 90% of cases but non-specific. AntidsDNA present in 60% of cases, and specific. Anaemia, leukopenia, thrombocytopaenia. ESR and CRP

DMARDs and steroids used in a similar way to RA. Treat organ and nerological involvements specifically and individually.

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

Source URL (retrieved on 09/03/2014 - 12:27): http://almostadoctor.co.uk/content/systems/orthopaedics-andrheumatology/arthritis/comparison-and-summary-types-arthritis

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

2/2