arthritis
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Etiology
- monoarticular
- oligoarticular
- spondyloarthropathy
- infection-related
- sarcoidosis (also polyarticular)
- amyloidosis[5]
- polyarticular
- lymphoma/leukemia in children[2]
- also see bone disease
Clinical manifestations
- general
- pain is elicited on both active & passive motion of joint
- joint line is painful or tender on palpation
- limited range of motion may be present
- may be pain associated with passive range of motion
- warmth, swelling, redness or effusion may be present
- fatigue, malaise & morning stiffness
- manifestations of specific etiologies
- heel pain in young man suggests spondyloarthropathy
- prolonged morning stiffness or pain in small or large joints suggests rheumatoid arthritis
- recurrent arthritis with hair loss & photodermatitis suggests systemic lupus erythematosus (SLE)
- painful arthritis with swelling developing overnight in the absence of trauma suggests gout (except young women)
- insidious onset of prolonged morning stiffness in one buttocks, then the other in a young man suggests ankylosing spondylitis
- asymmetric involvement of weight-bearing joints or involvement of interphalangeal joints with brief morning stiffness suggests osteoarthritis
- a single inflamed joint in a febrile patient suggests infection
- distal finger interphalangeal tenderness is common in psoriatic arthritis, occurs occasionally with Reiter'ssyndrome & may occur in initial phases of development of Heberden's nodes of osteoarthritis
- spondylitis is the hallmark of ankylosing spondylitis & occurs in 25% of patients with reactive & psoriatic arthritis
- fever, rash suggests inflammatory arthritis
Laboratory
- if arthritis has been of at least 3 months duration, initial diagnostic workup:
- joint aspiration with synovial fluid analysis
- indicated if suspected bacterial infection
- infection & crystalline arthritis can coexist
- WBC count > 2000/uL predominantly neutrophils suggests active inflammation
Radiology
- X-ray
- joint space narrowing (non-specific)
- symmetric joint space narrowing in rheumatoid arthritis
- asymmetric joint space narrowing in osteoarthritis
- erosions, periostitis (inflammatory arthritis)
- osteophytes, subchondral sclerosis (osteoarthritis)
- magnetic resonance imaging
- asymptomatic individuals frequently with abnormalities on MRI
- synovitis 48%, bone marrow edema 58%, tenosynovitis 17%
- only 28% with no inflammatory features
- only 22% without erosions[1]
- asymptomatic individuals frequently with abnormalities on MRI
- magnetic resonance imaging
Complications
- psychosocial stress & depression common[10]
Differential diagnosis
- pain on active but not passive motion of joint & tenderness elicited on palpation of structures around the joint suggests bursitis or tendonitis
- degenerative arthritis accompanying bone disease
- referred pain suggested by painless full range of motion
- infectious arthritis may co-occur with crystalline arthritis in hospitalized patients[4]
- hemarthrosis
Management
- trial of steroids, prednisone 40 mg PO QD for 6 days
- return to clinic in one week
- if good response to prednisone & seronegative (ANA, RF), begin hydroxychloroquine (9 month trial)
- see specific type of arthritis
More general terms
More specific terms
- chronic postrheumatic arthropathy (Jaccoud's arthropathy)
- crystalline arthritis (crytalline arthropathy)
- infectious arthritis (septic arthritis)
- inflammatory arthritis
- juvenile idiopathic arthritis
- migratory arthritis
- monoarticular arthritis
- neurogenic arthritis (neurogenic arthropathy)
- ochronosis
- oligoarticular arthritis
- osteoarthritis (OA)
- polyarticular arthritis
- rheumatoid arthritis (RA)
- spondylitis
- spondyloarthropathy (HLA B27-associated arthritis, seronegative spondyloarthropathy)
- synovitis
Additional terms
- arthralgia
- bone disease; osteopathia
- hydroxychloroquine (Plaquenil)
- prednisone (Deltasone, Orasone, Liquid Pred, Meticortin, Rayos)
References
- ↑ 1.0 1.1 Mangnus L et al. Magnetic resonance imaging-detected features of inflammation and erosions in symptom-free persons from the general population. Arthritis Rheumatol 2016 Nov; 68:2593 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27213695
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16. 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018
- ↑ Weiner S, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 4.0 4.1 Papanicolas LE et al. Concomitant septic arthritis in crystal monoarthritis. J Rheumatol 2012 Jan; 39:157 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22133623
- ↑ 5.0 5.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ Finzel S, Ohrndorf S, Englbrecht M et al A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum. 2011 May;63(5):1231-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21538312
- ↑ Waits JB. Rational use of laboratory testing in the initial evaluation of soft tissue and joint complaints. Prim Care. 2010 Dec;37(4):673-89, PMID: https://www.ncbi.nlm.nih.gov/pubmed/21050950
- ↑ Helmick CG, Felson DT, Lawrence RC et al Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008 Jan;58(1):15-25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18163481
Lawrence RC, Felson DT, Helmick CG et al Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008 Jan;58(1):26-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18163497 - ↑ Jacobson JA, Girish G, Jiang Y, Sabb BJ. Radiographic evaluation of arthritis: degenerative joint disease and variations. Radiology. 2008 Sep;248(3):737-47. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18710973
- ↑ 10.0 10.1 Price JD, Barbour KE, Liu Y, et al. State-Specific Prevalence and Characteristics of Frequent Mental Distress and History of Depression Diagnosis Among Adults with Arthritis - United States, 2017. MMWR Morb Mortal Wkly Rep 2020;68:1173-78. https://www.cdc.gov/mmwr/volumes/68/wr/mm685152a1.htm
- ↑ Arthritis Home Page Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/arthritis/