Presentation on theme: "Diagnosing inflammatory arthritis"— Presentation transcript:
1 Diagnosing inflammatory arthritis Dr Jane BleaselRPAH
2 What is inflammatory arthritis? Inflammation in jointsInflammation in synovium (lining of joints) = synovitis Joint effusionsInflammation in tendon sheaths = tenosynovitis+/- Systemic features of inflammation fever, fatigue, weight loss
4 Inflammatory arthritis HISTORY IS KEY SymptomsSTIFFNESS IN JOINTS, esp early morning aftr inactivity, > 30 minutes, may be many hoursStiffness improved with activity, hot showerSwellingPain (not specific to inflammatory arthritis)Limitation of movement (not specific)+/- constitutional symptoms: fever, weight loss, fatigue, anorexia
6 History is the key Pattern of joint involvement Nature of onset Symmetrical or asymetrical, peripheral joints or spinal jointsNature of onsetAcute, subacute or chronicIs there evidence of a systemic process?Are there extra-articular features?
7 History is the key Pattern of joint involvement Nature of onset Symmetrical or asymetrical, peripheral joints or spinal jointsNature of onsetAcute, subacute or chronicIs there evidence of a systemic process?Are there extra-articular features?
8 Case history 145 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.
11 What other investigations? RFANAif ANA +, dsDNA, ENASLE inflammatory arthritis looks the same as RAEarly scleroderma has diffusely “puffy” handsXray hands and feet for erosions
12 Xray of handSoft tissue swellingPara-articularosteoporosis
13 Investigations Case 1 RF + 320 IU/ml ANA + 1:80 dsDNA negative, ENA negativeXrays: soft tissue swelling, para-articular ostoporosisDiagnosis: rheumatoid arthritis
14 “Rheumatoid-like” arthritis If fever, rash, marked systemic features think of viral arthritides:Viral causesRoss River virusBarmah ForestHepatitis B (arthritis precedes jaundice)RubellaParvo B19 virusEBV