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    Rheumatology: Differential Diagnoses of Arthritis

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    Sok-Moi Chok
    This document summarizes key information about various types of arthritis: - Osteoarthritis most commonly affects hands, hips and knees, presenting with pain on joint movement and reduced range of motion. Treatment focuses on pain management, physiotherapy and joint replacement surgery. - Rheumatoid arthritis typically causes symmetrical inflammation of small joints like the hands and feet. It has genetic and environmental risk factors and is diagnosed through clinical examination and blood tests. Treatment involves steroids, DMARDs and anti-TNF drugs to reduce joint damage and inflammation. - Gout usually causes sudden hot, swollen attacks in single joints like the big toe or hands. It is associated with purine-rich diets and alcohol and is treated

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Rheumatology: Differential Diagnoses of Arthritis

    Uploaded by

    Sok-Moi Chok
    347 views3 pages
    This document summarizes key information about various types of arthritis: - Osteoarthritis most commonly affects hands, hips and knees, presenting with pain on joint movement and reduced range of motion. Treatment focuses on pain management, physiotherapy and joint replacement surgery. - Rheumatoid arthritis typically causes symmetrical inflammation of small joints like the hands and feet. It has genetic and environmental risk factors and is diagnosed through clinical examination and blood tests. Treatment involves steroids, DMARDs and anti-TNF drugs to reduce joint damage and inflammation. - Gout usually causes sudden hot, swollen attacks in single joints like the big toe or hands. It is associated with purine-rich diets and alcohol and is treated

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    Rheumatology: notes on differential diagnoses of arthritis and their presentations.

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    This document summarizes key information about various types of arthritis: - Osteoarthritis most commonly affects hands, hips and knees, presenting with pain on joint movement and reduced range of motion. Treatment focuses on pain management, physiotherapy and joint replacement surgery. - Rheumatoid arthritis typically causes symmetrical inflammation of small joints like the hands and feet. It has genetic and environmental risk factors and is diagnosed through clinical examination and blood tests. Treatment involves steroids, DMARDs and anti-TNF drugs to reduce joint damage and inflammation. - Gout usually causes sudden hot, swollen attacks in single joints like the big toe or hands. It is associated with purine-rich diets and alcohol and is treated

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    347 views3 pages

    Rheumatology: Differential Diagnoses of Arthritis

    Uploaded by

    Sok-Moi Chok
    This document summarizes key information about various types of arthritis: - Osteoarthritis most commonly affects hands, hips and knees, presenting with pain on joint movement and reduced range of motion. Treatment focuses on pain management, physiotherapy and joint replacement surgery. - Rheumatoid arthritis typically causes symmetrical inflammation of small joints like the hands and feet. It has genetic and environmental risk factors and is diagnosed through clinical examination and blood tests. Treatment involves steroids, DMARDs and anti-TNF drugs to reduce joint damage and inflammation. - Gout usually causes sudden hot, swollen attacks in single joints like the big toe or hands. It is associated with purine-rich diets and alcohol and is treated

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    RHEUMATOLOGY: ARTHRITIS| S.M.

    CHOK (Manchester Medical School)


    Disease
    Osteoarthritis

    Location
    Hands, Hips,
    Knees
    Poly/ oligo /
    monoarthritis

    Rheumatoid
    Arthritis

    Hands,
    shoulders,
    feet,
    sometimes
    knees
    symmetrical
    small joints
    polyarthritis

    Examination

    Presentation

    Epidemiology

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

    Gradual onset (over


    years), gradual
    increase in main
    and reduction in
    function

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

    Most apparent at the


    hands: MCP, PIP,
    wrist joints, NOT DIP
    joints.

    Early morning
    stiffness, lasts for
    several hours
    (improve with
    activities).

    Joints: warm and


    tender, pain and
    stiffness
    Deformities (Zthumb, swan neck,
    subluxation,
    boutonniere etc).
    Muscles: wasting,
    inflamed flexor
    tendon sheaths
    Nodules common on
    the forearm,
    especially at pressure
    points.
    Signs of steroid use
    (bruising)

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

    Investigations

    Treatment

    X-ray! Will show joint


    space narrowing,
    sclerosis of bone
    margins, cyst
    formation,
    osteophyte formation

    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

    Very variable. Some


    may come on
    acutely overnight,
    others over several
    weeks or months.
    Often the first signs
    in the feet (walking
    on marbles)
    Worse in summer
    or hot weather

    M:F = 1:2
    risk if 3x higher
    before
    menopause
    same risk after
    menopause
    Can be any age,
    most commonly
    30-50.

    Genetic factors involved.


    HLA-DL1: poor prognosis
    HLA-DL4: 50-75% of pts, poor
    prognosis
    ?contraceptive pills delay onset
    but do not reduce risk
    ?sex hormones involvement

    Rheumatoid factor:
    only present in 50%
    of cases.
    Anti-CCP more
    specific.
    Blood tests
    anaemia
    ESR and CRP raised.

    Smoking, stress, infection.


    Diagnosis usually
    clinical, imaging not
    widely used

    Steroids can be used


    to induce remission in
    acute disease.
    Sometimes given longterm, 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.

    RHEUMATOLOGY: ARTHRITIS| S.M.CHOK (Manchester Medical School)


    Others:
    shoulders, knees,
    feet, elbow (less
    common) affected
    carpal tunnel
    eyes: dry, scleritis,
    episcleritis
    anaemia (normocytic/chromic)
    Sjogren: dry eyes
    and mouth
    Raynaud's
    Kidney: nephrotic
    syndrome, failure
    Lungs: pleural
    effusion, pleurisy,
    fibrosis (lower)
    Heart: pericarditis
    Gout

    Hands, Feet
    Monoarthritis

    Pseudogout

    Knee, hands,
    elbows,
    shoulder,
    Tarsal joints
    Monoarthritis

    Gouty tophi
    (chronicgout), hot,
    red, tender, swollen
    joint.

    Hot, red, tender,


    swollen joint.

    Acute episodes
    last up to 7 days.
    Hot, red, tender,
    swollen joint
    Chronic presents
    with gouty tophi.

    Acute hot, red,


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

    Much more
    common in men
    (10:1). Some
    cases are
    genetically
    inherited (Xlinked), most
    cases have a
    genetic
    component.
    Age related
    urate acid levels
    rise with age.

    Associated with a diet high in


    purines (meat) and alcohol.
    Thiazidediuretics greatly
    increase the risk.
    Anything that increases the
    level of purines or urates in the
    blood e.g. high rate of cell
    death chemotherapy!

    Aspiratie joint rule


    out infection, check
    for crystals (needle
    shaped, negatively
    birefringent)
    Serum urate raised
    in 60% (not
    diagnostic), Inflam
    markers , x-ray
    may show punched
    out erosnions, and
    flecked calcifications

    Increases with
    age.Often
    accompanies OA

    Phosphatemetabolismdisorders

    Aspiratie joint rule


    out infection, check
    for crystals(rhomboid,
    positively
    birefringent)

    Acute use NSAIDs to


    relieve acute attack,
    then start allopurinol.
    Chronic allopurinol is
    the Tx 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, ororal
    steroids are usually the
    first line.
    No real allopurinol

    RHEUMATOLOGY: ARTHRITIS| S.M.CHOK (Manchester Medical School)


    Systemic
    Sclerosis

    Systemic
    multi-organ
    involvement,
    (often lungs
    and
    oesophagus)
    usually with
    hand signs

    Hands and arms:


    pigment changes,
    telangiectasia,
    sclerodactyly, digital
    pitting, Reynauds,

    SLE

    Systemic.
    Typically
    photosensitive
    skin rashes
    (often on the
    face), and
    organ
    involvement
    (most
    commonly
    kidneys)

    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

    Often lots of nonspecific symptoms


    low-grade fever,
    tiredness, general
    malaise. May also
    have multi-organ
    involvement.
    Mouth ulcers, hair
    loss,
    Reynauds,depressi
    on

    Any age, most


    commonly 30-50.
    4x as common in
    women

    Genetic factors

    10x as common in
    women. Any age,
    often between
    25-35, and
    between 5-60

    Smoking, stress. Genetic factors

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

    ANAs present in
    90% of cases but nonspecific. Anti-dsDNA
    present in 60% of
    cases,
    andspecific.Anaemia,
    leukopenia,
    thrombocytopaenia.
    ESR and CRP

    DMARDs and steroids


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

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