Inflammatory arthritis Flashcards
What is inflammatory arthiritis
- what are the main symptoms
- describe the epidemiology
Immune system dysfunction => inflammation causes pain, swelling, heat, stiffness
Accompanied by fatigue
Occurs at any age in both sexes
How would you differentiate between inflammatory or mechanical pain
Pain for 3+ months
New onset in younger people, no clear injury or trigger
Early morning stiffness that lasts more than 30mins
Persistent pain affecting tendon, ligament insertions
Night pain
Atraumatic joint swelling
May be accompanied withs systemic features, extraarticular disease
What investigations would you order (imaging)
-what are you looking for
Xray => joint changes
USS => joint inflammation
What investigations would you order (blood tests)
-what are you looking for
ESR, CRP => inflammation
Serum uric acid => raised in gout
Autoantibodies => rheumatoid factor, antiCCP
Cultures => infection may be present, with or without fever
What other investigations would you order (fluid analysis)
-what are you looking for
Synovial fluid => culture, gram staining, crystals to exclude infection of a joint
What are the autoimmune differentials for synovitis
SLE arthiritis => non deforming polyarthiritis
Psoriatic arthritis => small joints, psoriasis
Sarcoidosis => with lung and skin symptoms
Seronegative spondyloarthiritis => group of arthropathies, history of back pain, bowel issues, psoriasis
RA => persistent synovitis with no clear cause, symmetrical, rheumatoid nodules
What are the inflammatory/infective differentials for synovitis
Infective/septic arthritis => especially if there is an ongoing infection. Monoarticular, hot, swollen, septic
Gout => tophi
Reactive arthiritis => recent infection but no direct infection in joints. Symmetrical hand, feet arthritis
What are the degenerative causes of synovitis
Osteoarthritis => generally in elderly, worse on movement
What are the environmental causes of synovitis
Polymyalgia rheumatica => pain, stiffness in SHOULDER, NECK, HIP, temporal arteritis
What are the functional causes of synovitis
Fibromyalgia => somatic symptoms and muscle pain
How would you manage inflammatory arthritis
DMARDS => reduce immune response
NSAIDS, corticosteroids => management of flares
Vaccines => annual flu, regular pneumococcal
