Arthritis History

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Arthritis History

What joint is involved

Is it acute or chronic

Is the process inflammatory or mechanical

Is the arthritis truly monocular

Gastro- diarrhoea, dysentery

Urogentital- discharge, dysuria, ulcers

Eyes- red , sore, conjunctivitis, dry

Spinal symptoms- pain, stiffness, posture

Skin- rashes, psoriasis, mouth, ulcers

Drugs- aspirin, warfarin, diuretic

Does the problem arise from the joint/muscle or tendon?

Acute or chronic?

Inflammatory or non-inflammatory?

Pattern of joint involvement?

Impact on patient’s life

Are other organs involved?

Are there systemic symptoms?

Differential diagnosis of acute mono arthritis ->

Trauma

Sepsis

Crystal shedding

Haemarthrosis

Reactive arthritis

Monoarticular presentation of RA or other inflammatory arthritis

Investigating monoarthritis ->

Synovial fluid analysis

Synovial fluid WBC >5000 means inflammatory arthritis

Arrange:

Gram stain

Crystal exam

Cultures

Alizarin red stain

In the absence of a synovial fluid specimen, look for clinical signs of inflammation. Check ESR and CRP. Use these markers as a surrogate for an inflammatory synovial fluid.

Consider: septic arthritis, gout, pseudo gout, autoimmune

Synovial fluid analysis -> is this a bloody or non bloody effusion

Causes of haemarthrosis ->

Trauma

Bleeding disorder (haemophilia, scurvy, warfarin)

Osteoarthritis

Vilonodular synovitis

Charcot joint

Haemangioma/ vasc malformations

Tumours

Amyloid

Infection

Investigations for haemarthrosis ->

Plain X-rays

Coagulation studies

MRI scan

Arthroscopy / Synovial biopsy

Noninflammatory mono arthritis non bloody effusion ->

Arrange a plain x ray and consider patient age

For a younger patient ->

Osteochondritis.

Ischaemic necrosis.

Internal derangement.

Congenital.

Periarticular process.

For an older patient ->

Osteoarthritis.

Neuropathic.

Other causes.

Oligoarthritis ->

2-4 swollen joints

Consider ->

‘ The seronegative spondylo-arthropathies’

psoriatic arthritis

reactive arthritis

ankylosing spondylitis

inflammatory bowel disease

Investigations to perform ->

ESR/FBC

CRP

Synovial fluid analysis

Rheumatoid factor

Chest-x-ray

X-ray S-I joints

Polyarthritis ->

More than 4 swollen joints

Consider:

viral arthropathies

rheumatoid arthritis

systemic lupus erythematosus

scleroderma

Reasons for investigations in inflammatory arthritis :

Classify inflammatory arthritis

Determine disease activity

Extent of joint damage

Determine organ function for baseline and decision making regarding drugs treatment

Investigating poly arthritis ->

ESR/FBC

CRP

LFTs / E&U &Creat

RF / ANA

Synovial fluid analysis

Chest X-ray

X-ray hands and feet

Immunological investigations: Rheumatoid factor, ANA

Treatment ->

Control inflammation early and prevent joint damage

Early use of DMARDs singly or combination

Use of anti-TNF agents

? use B-cell depletion therapy

Common causes of arthritis ->

1. Monoarthritis

Septic

Crystal

Psoriatic

OA

2. Oligoarthritis

Psoriatic arthritis

Enteropathic arthritis

OA

3. Polyarthritis

Rheumatoid arthritis

SLE (Lupus)

Sjogren’s syndrome

Psoriatic arthritis

OA

Spine – spondyloarthropathy (AS/PsA/enteropathic), OA, disc disease