Arthritis

Overview 

Once arthritis is suspected, physicians should distinguish between noninflammatory and inflammatory forms of arthritis while recognizing potentially disabling and life-threatening problems.

Remember Rule out septic arthritis in any monoarthritic presentation, prolonged diagnosis results in irreversible joint damage.
Definition
Polyarthralgia: multiple joint pain without synovities.
Polyarthritis: inflammation of 4 or more joints (synovitis).
MonoarthropathyOligoarthropathyPolyarthropathy
Septic arthritisCrystal arthritisRheumatoid arthritis
Crystal arthritis (Gout)Psoriatic arthritisViral Arthritis
Osteoarthritis (can be mono-poly)Reactive arthritisAutoimmune connective tissue disease (ie. SLE)
Trauma (Haemarthrosis)Ankylosing spondylititisVasculitides (ie. Polymyalgia Rheumatica)

Approach

  • History
    • Sex
    • Age of onset
    • Pattern of arthritis
    • Extra-articular features
    • Which joints affected
      • peripheral symmetrical arthritis – Rheumatoid arthritis
      • Asymmetric with enthesitis and back pain – spondylarthritis
      • DIP joints with synovitis – psoriatic arthritis
Age
ChildTrauma, Congenital, slipped capital femoral epihpysis, Juvenile rheumatoid arthritis
Young AdultsReactive arthritis, gonococcal, SLE
Older patientsAcute gout and Pseudogout, Rheumatoid arthrits
  • Examination
    • Psoraiasis
    • Malar rash – SLE
    • Kerataderma blenorrhagica – Septic arthritis
    • Salmon
  • Investigations

Differential Diagnosis

Arthritis can be divided into:

  • Acute or chronic
  • Monoarthritis, Oligoarthritis, Polyarthritis
  • Inflammatory and non-inflammatory
  • Seropositive or seronegative

Non-inflammatory Arthritis

Inflammatory Arthritis

  • Crystal arthropathy
  • Infectious
  • Seronegative arthritis
    • Ankylosing spondylitis
    • Psoriatic arthritis
    • Reactive arthritis
    • IBD arthritis
  • Seropositive arthritis
    • Rheumatoid Arthritis
    • Scleroderma
    • Vasculitis
    • Sjogren’s

Discussion

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