Pathogenesis; destruction of
articular cartilage > thickening of subarticular bone > osteophytes
in joints (Heberden's/Bouchard's nodes; cyst formation)
Symptoms; pain, limited
movement, oedema, paraesthesia (in spine)
Clinical classification;
Primary generalised osteoarthritis (Heberden's nodes on fingers, PMP women
effected), Erosive inflammatory osteoarthritis (rapid progression of
inflammation & erosion) & Hypertrophic osteoarthritis (ostephyte
formation/bone sclerosis, slowly progressive)
Autoimmune Arthritis
Seen in patients with; SLE,
rheumatic fever & systemic sclerosis (RF seropositive)
Systemic lupus erythematosus;
similar location to RA, rarely progressive & does not lead to chronic
disease/joint deformity
Rheumatic fever; affects
larger joints, transient features, no progression to chronic disease/joint
deformity
Systemic sclerosis; systemic
diseases affecting skin & organs, causes joint deformity like mild RA
Crystal Athropathies
Features crystal deposits in
joints & soft tissues
Urate gout ("True
gout"); due to hyperuricaemia, caused by underexcretion of uric
acid, overproduction of uric acid or enzyme defects of purine metabolism
(congenital) > commonly affects podagra, precipitated by purine rich
diet, pathogenesis; white powdery deposits within articular cartilage
> degeneration, clinical presentation; foreign-body giant cell
reaction > palpable mass (tophi)
Calcium pyrophosphate gout
("Pseudogout"); calcium deposits > producing
chondrocalcinosis (possibly asymptomatic, primary in elderly/secondary in
<60 with underlying cause, treated with reduced dietary calcium intake
Infective Arthritis
Aetiology; commonly pyogenic
bacteria infection due to; access via local trauma, adjacent infective
foci spread or bloodstream spread, prosthetic surgery or intra-articular
injections of steroids (non-sterile)
Diagnosed; cytological
examination of aspirated synovial fluid > will show elevated WBC &
ESR
Types;
Tuberculous arthritis; may
lead to osteomyelitis of VC > VC collapse > Pott's disease (in
adults), hip & knee (children), diagnosed with synovial biopsy &
culture analysis
Lyme disease; due to
Borrelia burgdorferi (from infected body lice/ticks) > erythema
chronicum migrans (peri bite) > chills, fever, fatigue, muscle aches
& lymphadenopathy
Seronegative Spondylarthritides (RF seronegative)
Aetiology; autoimmune
reaction associated with high levels of antigen HLA B27
Reiter's syndrome; comprised
of reactivearthritis, urethritis & conjunctivitis, may present with
"sausage digits", causes inflammation for ~6 months (no further
progression), prognosis; spontaneous resolution or persistent symptoms
Psoriatic arthropathy;
involves distal IP joints, symmetrical arthritis (sacroilitis &
spondylitis) > ostelytic destruction/similar to RA
Osteogenesis Imperfecta
Autosomal recessive/dominant
inheritance disorder > abnormal collage formation in osteoid >
spontaneous fracture or deformity