Inflammatory Arthritis: Polyarticular pain

Question 1

What is the definition for Polyarticular pain?

Answer 1

pain of 4 or more joints

Question 2

For Polyarticular pain what is classfication dependent on?

Answer 2

inflammatory and non-inflammatory and soft tissue pain

Question 3

list some inflammatory Polyarticular pain?

Answer 3

Spondyloarthropathies - inflammation of spine

Juvenile Idiopathic Arthritis - paediatrics - child with JIA they continue with that diagnosis into adult hood

Infection Related (usually transient – acute, self-limiting) - reactive arithitus

Question 4

what are some non-inflammatory polyarticular arthritis?

Answer 4

Osteoarthritis (OA) or Degenerative Arthritis

“wear & tear”

Numerically the commonest type of polyarthritis

Question 5

to know if its inflammatory arthritis?

Answer 5

other characterstitics of inflammatory arhritis: - early morning and inactivity stiffness - should ask how long it takes to get over(synovial fluid needs to have time to work), systemic symtoms (unwell, lethargy, wt loss or fever)

Calor, Rubor, Dolor, Tumor:

Heat/Warmth

Red/Erythema

Pain/Tenderness

Swelling

Usually parallels the degree of joint inflammation/disease activity - averages to 3.5hrs for RA.

Question 6

inflammatory vs non-inflammatory?

Answer 6

Inflammatory is potentially more serious

Many forms have systemic manifestations

Early recognition & intervention improves outcome

Question 7

common types of inflammatory arthritis:

• acute (self-limiting)

Answer 7

• infection related
  
  • viral e.g parvovirus, rubells (50% w/pain in joint after infection or vaccination), Hep B(up to 20% pts), EBV, HIV (5% Arthralgia, HIV associated arthitus)
  • bacterial: post dysentery or STD
  • streptococcus, mycoplasma or lyme disease
    
    • lyme disease: organsim is Borrelia Burgdoferi - gram -ve corkscrew shaped bacterim
      
      • 0.3/100,000
      • tick bourne - spreads in body
      • early - erythema migrans (rash that shows) and fever, malaise, headache, arthralgia, lymphadenopathy (swelling of glands)
      • late chronic skin and neuro and arithtius
      • doxocyclin? - easy enough to treat
    • rheumatic fever: seen with Grp A steptococcal infection
      
      • modified jones criteria:
        
        • Major – carditis, polyarthritis, erythema marginatum, subcutaneous nodules, chorea
        • Minor – prolonged P-R interval on ECG, arthralgia, fever, acute phase – e.g. CRP/ ESR
        • two major or two minors with 1 major
        • 60% have rheumatic heart disease at 10 yrs
        • throat swab and blood test - soar throat and not improving
    • TB - mycobacterial infection:
      
      • slow growing - difficult to pick up
      • spinal (Pott’s diease of the spine - usually thoractic)
      • arthritis with synovial disease (ASPIRATE THE JOINT)
      • Osteomyelitis – infection in bone (2-3% of all bone infection)
      • Soft tissue disease
      • Systemically unwell, weight loss, slow growing infection, with bone / joint destruction – cold abscesses
    • Brucellosis:
    • Chronic granulomatous infection
    • Small gram negative bacteria
    • consumption of unpasteurised milk

Question 8

How does acute inflammatory arithitus present?

Answer 8

• sudden onset
• fever + systemic upset
• variable severity
• self-limiting
• 6-12 week duration

Question 9

Describe viral arthritis

Answer 9

• Arthralgia - common and may last a few weeks
• usually self limiting
• may follow vaccination
• symmetrical polyarhropathy
• more common in women than men/children

Question 10

Describe chronic arthritis?

Answer 10

• RA: symmetrical small joint inflammatory arthritis that lasts more than 6 weeks
• can be linked to nodules (develop at pressure points)
• psoriatic arthritis - more middle joints affected
• skin is peeling over inflammation joint related to gout - pedagra

Question 11

How to assess a patient?

Answer 11

• no single test, need pt history, exam, lab test and imaging
  
  • blood test
    
    • FBC= look at Hb, platlets
    • ESP or CRP - inflammatory response - not always high
    • RF,ANA (test for connective tissue disorders), anti CCP, HLA-B27 (genetic marker)
    • uric acid
    • synovial fluid anaylsis - organisms, cystals

Question 12

oa - list demographics:

Answer 12

OA:- scale of problem - causes in other lecture

• Commonest type of polyarthritis
• Prevalence rises steeply with age
• 3% of adult population have symptomatic OA
• 10-20% at age 40
• 75% > 65 have radiographic evidence of OA
• f > M
• Considerable economic & social costs