Armando Hasudungan
Biology and Medicine videos

Arthritis

75yo presents with right knee pain gradually worsening over past year. Also complains of pain and stiffness around finger joints particularly in the morning.

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)
Monoarthropathy Oligoarthropathy Polyarthropathy
Septic arthritis Crystal arthritis Rheumatoid arthritis
Crystal arthritis (Gout) Psoriatic arthritis Viral Arthritis
Osteoarthritis (can be mono-poly) Reactive arthritis Autoimmune connective tissue disease (ie. SLE)
Trauma (Haemarthrosis) Ankylosing spondylititis Vasculitides (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
Child Trauma, Congenital, slipped capital femoral epihpysis, Juvenile rheumatoid arthritis
Young Adults Reactive arthritis, gonococcal, SLE
Older patients Acute 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

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