Professional Documents
Culture Documents
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
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
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
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
Pseudogout
Acute hot, red, tender swollen joints. Chronic can resemble RA, or OA. Often interspersed with acute epdisodes
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
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
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
http://almostadoctor.co.uk/print/content/systems/orthopaedics-and-rheumatology/arthritis/comparison-and-summary-types-arthritis
2/2