Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by tests such as radiologic imaging and blood tests, depending on the type of suspected arthritis. Pain patterns may vary depending on the type of arthritis and the location.
Rheumatoid arthritis is generally worse in the morning and associated with stiffness lasting over 30 minutes. On the other hand, with osteoarthritis, the pain tends to initially be related to activity and then becomes more constant over time. Important features to look out for include the following: • Rate of onset of symptoms • Pattern of joint involvement • Symmetry of symptoms • Early morning stiffness • Associated tenderness around the joint • Locking of joint with inactivity • Aggravating and relieving factors, and/or • Presence of systemic symptoms Physical examination may include observing the affected joints, evaluating gait, and examining the skin for findings that could be related to rheumatological disease or pulmonary inflammation. Physical examination may confirm the diagnosis or may indicate systemic disease. Chest radiographs are often used to follow progression or help assess severity. Screening blood tests for suspected arthritis include:
rheumatoid factor,
antinuclear factor (ANF),
extractable nuclear antigen, and specific antibodies.
Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis. It affects humans and other animals like dogs, cats, and horses. It can affect both the larger joints (i.e. knee, hip, shoulder, etc.) and the smaller joints (i.e. fingers, toes, foot, etc.) of the body. Caused by daily wear and tear of the joint, this can speed up its progression. OA results from cartilage breakdown, leading to bones rubbing directly and eroding each other. The symptoms typically begin with minor pain during physical activity, but can eventually progress to be present at rest. The pain can be debilitating and prevent one from doing activities that they would normally do as part of their daily routine. OA typically affects the weight-bearing joints, such as the back, knee and hip due to the mechanical nature of this disease process. Unlike rheumatoid arthritis, OA is more common in the elderly, with increased age being the strongest predictor, likely due to declining
chondrocytes ability to maintain cartilage. Over 30 percent of women have some degree of OA by age 65. Diagnosis consists of the primary tools for diagnosing OA are X-rays of the joint. Findings on X-ray that are consistent with OA include those with joint space narrowing (due to cartilage breakdown), bone spurs, sclerosis, and bone cysts.
Rheumatoid arthritis s by
rheumatoid arthritis Rheumatoid arthritis (RA) is a disorder in which the body's own immune system starts to attack body
tissues specifically the cartilage at the end of bones known as articular cartilage. The attack is not only directed at the joint but to many other parts of the body. RA often affects joints in the fingers, wrists, knees and elbows, is symmetrical (appears on both sides of the body), and can lead to severe progressive
deformity in a matter of years if not adequately treated. RA usually onsets earlier in life than OA and commonly effects people aged 20 and above. In children, the disorder can present with a skin
rash,
fever,
pain, disability, and limitations in daily activities. One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the
synovium (lining of the joint capsule), caused in part by the production of pro-inflammatory
cytokines and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts. Osteoclast activity can be directly induced by osteoblasts through the RANK/RANKL mechanism.
Lupus Lupus is an autoimmune
collagen vascular disorder that can be present with severe arthritis. In fact, about 90% of patients with Lupus have musculoskeletal involvement. Symptoms in these patients can often mimic those of rheumatoid arthritis with similar stiffness and pain patterns. Joints in the fingers, wrist, and knee tend to be the most affected.
Gout In the early stages of gout, usually only one joint is affected; however over time, many joints can become affected. Gout most commonly occurs in joints located in the big toe, knee, and/or fingers. When one of these flares occurs, management involves the use of anti-inflammatories, such as NSAIDs, colchicine, or glucocorticoids. In between gout flares, it is recommended that patients take medications that decrease the production of uric acid (i.e. allopurinol, febuxostat) or increase the elimination of uric acid from the body (i.e. probenecid). Gout has been associated with excessive intake of alcohol and food, such as red meat. Unlike gout, no targeted treatments are currently available. Only about 1% of cases of infectious arthritis are a result of
viruses. Within recent years, the virus
SARS-CoV-2, which causes
COVID-19, has been added to this list. SARS-CoV-2 tends to cause
reactive arthritis rather than local septic arthritis. == Treatment ==