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ARTHRITIS
DR. MOHAMMED O. AL-RUKBAN
Assistant Professor
Department of Family and Community Medicine
College of Medicine
King Saud University
Normal Joint..
Introduction..
Fibromyalgia
Bursitis
Tendinitis
Hypothyroidism
Neuropathic pain
Metabolic bone disease
Depression
Monoarthritis..
Trauma
Infection:
DGI ± Skin lesion.
Nongonococcal bacterial infections: large joints.
Mycobacterial and fungal infection.
Crystal induced arthritis
Monosodium Urate crystals (MPJ)
Ca pyrophosphate dihydrate crystals (knee)
Lyme disease
Systemic Rheumatoid diseases:
Seronegative spodyloarthropathy (Reactive arthritis, psoriatic
arthritis, Inflammatory BD..)
Sarcoid periarthritis
RA
Osteoarthritis
Polyarthritis..
Rheumatoid Arthritis
Systemic lupus Erythrematosus
Viral arthritis
Reiter’s disease
Psoriatic arthritis
Reactive arthritis
Migratory Arthritis..
Differential diagnosis:
Rheumatic fever
Gonococcemia
Meningococcemia
Viral Arthritis
SLE
Acute Leukemia
Rheumatic Fever..
Majer Criteria:
1- Carditis 2- Polyarthritis 3- Chorea
4- Erythema Marginatum 5- Subcutaneous nodules
● Minor criteria:
1- Arthralgia 2- Ferver 3- Acute phase reactant
(ESR, CRP).
4- Prolong PR interval 5- Evidence of group A
streotococcal infection (AST, Throat culture…)
History.. Age
Associated Sx:
Multi-system involvement= Systemic
rheumatic diseases.
Past Medical history:
Trauma, fracture, surgical procedures…
Medication list:
Drug induced lupus.
Diuretics.
Phy. Examination..
Joint:
Soft tissue swelling, warm, effusion…=
Inflammation.
Inflammation signs extended= septic
arthritis, crystal induced arthritis, fracture.
Passive motion (N), active(↓↓)= bursitis,
tendinitis, muscle injury.
Passive motion (↓↓), active(↓↓)= Synovitis
Phy. Examination..
General Examination:
LAP, parotid enlargement, oral ulceration, heart
murmurs, pericardial or pleural friction rubs,
crackle…= systemic disease.
Fever= infection, reactive arthritis, RA, SLE,
Crystal induced arthritis…
Subcutaneous nodules= RA, RHD, Gout (tophi)
Skin manifestations= psoriasis, RA, SLE…
Eye disease (keratoconjunctivitis sicca, uveitis.
Conjunctivitis, episcleritis…)
Laboratory Studies..
Can be misleading.
Basic: CBC, Urinalysis, U&E, LFT.
Acute phase reactant: ESR, CRP.
Antibody tests:
ANA= SLE
Anti-dsDNA= SLE
Anti-native DNA, anti-Sm= SLE
RF= RA
Anti-CCP antibody=RA
Rheumatoid Factor..
Rheumatoid Arthritis
Connective tissue diseases
Viral infection
Leishmaniasis
Leprosy
Tuberculosis
Sarcoidosis
Liver diseases
Subacute bacterial endocarditis
Laboratory Studies..
X-ray:
RA
Chronic Gout
OA
Ankylosing spondylosis.
MRI:
Ankylosing spondylosis.
Rheumatoid Arthritis..
Epidemiology :
The world wide incidence of RA is
approximately 3 cases per 10,000
population and the prevalence rate is
approximately 1%
..Rheumatoid Arthritis
..History
Malaise
fever
fatigue
weight loss
myalgias
difficulty performing activities of daily
living
..Examination
Joint affected
swelling
tenderness
warmth
decreased range of motion
Atrophy of the interosseous
muscles
deformities
..Diagnosis
Morning stiffness
Arthritis of 3 or more joint areas
Arthritis of hand joints of at least one area
swollen in a wrist, MCP, or PIP joint
Symmetric arthritis
Rheumatoid nodules
Serum RF
Radiographic changes typical of RA
..Deformities
..Extra-articular manifestations
Rheumatoid nodule
Cardiovascular
Pulmonary
GI & Renal
Hematological
Skin
Vasculitis
Neurological
Ocular
Progression of RA..
Stage 1:
- no destructive changes.
- Osteoporosis.
Stage 2:
- periarticular osteoporosis w/wo slight
subchondral bone destruction.
- joint mobility limit but no destruction.
- adjacent muscle atrophy.
- extra-articular soft tissue lesions.
Progression of RA..
Stage 3
- cartilage and bone destruction in addition to
periarticular osteoporosis.
- joint deformity w/wo fibrous or bony ankylosis.
- extensive muscle atrophy.
- extra-articular soft tissue lesions.
Stage 4
- criteria of stage 3.
- fibrous or bony ankylosis.
.. Laboratory
Hematologic parameters
Anaemia
Thrombocytosis
↓ Serum iron & IBC
↑ Serum globuline
↑ ALP
↑ Acute phase reactant
Immunological parameters
Synovial fluid analysis
Prognosis..
Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Renal disease (proteinuria, cellular cast)
Neurologic disease (seizure, psychosis)
Hematologic disease
Immunologic abnormalities
ANA
Summary..
Use of time.
In one study: 60% of patients with early
synovitis diagnosed as:
Rheumatoid Arthritis.
Spondyloarthropathy.
20% had a self limited arthritis.
20% unclassifiable with good prognosis.
In another study: 36% unclassifiable
When to refer?