The Spectrum Of Arthritis

15.1.07

What is arthritis?
• Damage to joints.
• Pain (usually).
• Reduced function - "joint failure."
• Many causes.
• Various treatments - including curative!

Spectrum of arthritis
• Aches and pain very common.
• Not all pains are "arthritis."
• Hundreds of different types of arthritis.
• Average doctor: poor/no training in musculoskeletal disease.
• Importance of early diagnosis (modifiable disease).
• Massive market - pharmaceutical industry!
• One, few or many joints affected.
• Not only joints affected!
• Many different aetiologies.

How to diagnose arthritis
• History.
• Examination.
• Blood tests:
-ESR.
-CRP.
• Imaging:
-X-ray.
-MRI.
-Ultrasound.
-Nuclear medicine.

Aetiology of rheumatic diseases
• Almost all have complex multifactorial aetiology.
• Multiple genes.

Clinical problems
• Single joint (monoarthritis).
• Many joints (polyarthritis).
• A few joints (oligoarthritis).

Aetiology
• Infective (septic).
• Degenerative (osteoarthritis).
• Metabolic (gout).
• Inflammatory (rheumatoid arthritis).

Monoarthritis
• Septic arthritis - can be sexually transmitted.
• Osteoarthritis.
• Crystalarthritis.

Septic arthritis
• Medical emergency.
• Curable.
• Antibiotics IV.
• Lose joint (and limb) if too slow.

Gout
• Podagra.
• Pain "exquisite."
• High serum urate.
• Crystals in joints.
• Profound inflammation.
• Chronic:
-Trophic.
-Renal disease.

Gout: diagnosis
• Serum urate.
• Direct examination for crystals.
• Look at underlying causes.

Pyarthrosis
• Sepsis.
• Crystal synovitis.
• Rheumatoid arthritis (and other inflammation).

Oligoarthritis
• Reactive (HLA-B27-related) arthritis.
• [Psoriatic arthritis.]
• Osteoarthritis.

Reactive arthritis
• As consequence of infection.
• Joint pain.
• Eye problems.
• Ulceration.

Ankylosing spondylitis
• More common in men than women (4-9:1).
• Inflammation in sacroiliac joint, spreading up back.

Psoriatic arthritis
• As result of psoriasis.
• Can be one of worst forms.

Osteoarthritis
• Joint "wearing" inevitable with time.
• When is "wear" "disease"?
• Various patterns: one/many joints.
• Surgery ultimate therapy.
• Lifestyle modification.
• Simple analgesia.
• Disease modification…?

Degenerative disease
• Cardinal features of arthritis on x-ray:
-Joint space narrowing.
-Osteophytes.

Rheumatoid arthritis
• Most common autoimmune disease.
• Not just joints.
• High morbidity.
• High mortality.
• Symmetrical small joint polyarthritis (only synovial).
• Inflammatory.