diagnosing inflammatory arthritis dr jane bleasel rpah
Post on 21-Dec-2015
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What is inflammatory arthritis?
• Inflammation in joints• Inflammation in synovium (lining of joints)
= synovitis Joint effusions
• Inflammation in tendon sheaths= tenosynovitis
• +/- Systemic features of inflammationfever, fatigue, weight loss
Inflammatory arthritisHISTORY IS KEY
• Symptoms– STIFFNESS IN JOINTS, esp early morning aftr
inactivity, > 30 minutes, may be many hours
– Stiffness improved with activity, hot shower
– Swelling
– Pain (not specific to inflammatory arthritis)
– Limitation of movement (not specific)
– +/- constitutional symptoms: fever, weight loss, fatigue, anorexia
Inflammatory arthritis- signs
• Signs of inflammation– Warmth– Redness (not always present)– Tenderness– Swelling, soft tissue, boggy sensation +/-
effusions
History is the key• Pattern of joint involvement
– Symmetrical or asymetrical, peripheral joints or spinal joints
• Nature of onset– Acute, subacute or chronic
• Is there evidence of a systemic process?
• Are there extra-articular features?
History is the key
• Pattern of joint involvement– Symmetrical or asymetrical, peripheral
joints or spinal joints
• Nature of onset– Acute, subacute or chronic
• Is there evidence of a systemic process?
• Are there extra-articular features?
Case history 1• 45 year old women, gradual development of
pain, swelling & stiffness small joints of hands and wrists. Also noticed pain and stiffness under balls of feet and knees. Joints stiff in mornings for around 2 hours, improved with movement. Feeling fatigued.
• Physical examination: symmetrical swelling over MCPs, PIPs, wrists, soft tissue swelling, reduced grip strength.
Investigations
• Hb 105, MCV 85, plts 500, WCC 8.7
• ESR 65, CRP 30
• UEC, LFT normal
• What other investigations?
What other investigations?
• RF
• ANA
• if ANA +, dsDNA, ENA– SLE inflammatory arthritis looks the same as
RA– Early scleroderma has diffusely “puffy” hands
• Xray hands and feet for erosions
Investigations Case 1
• RF + 320 IU/ml
• ANA + 1:80
• dsDNA negative, ENA negative
• Xrays: soft tissue swelling, para-articular ostoporosis
• Diagnosis: rheumatoid arthritis