1. A BASIC APPROACH TO DIAGNOSIS IN JOINT DISEASES

2. IS IT ARTHRITIS OR NOT? ARTHRITIS OR ARTHRALGIA

3. AN IDENTIFIABLE PATHOLOGICAL PROCESS INVOLVING JOINTS MUST BE PRESENT

4. IS IT AN INFLAMMTORY PROCESS OR NOT

5. INFLAMMATION SYSTEMIC EFFECTS TARGET ORGAN EFFECTS

6. REDNESS HEAT SWELLING PAIN LOSS OF FUNCTION

8. Soft tissue swelling Early morning joint pain and stiffness

9. INFLAMMATORY>5,000 white cells/ mm³ “NON-INFLAMMATORY”<1,000 white cells/mm³

12. SYSTEMIC EFFECTS OF INFLAMMATION 1.CLINICAL tiredness wt loss fever growth retardation 2.LABORATORY acute phase reactants

15. Haemoglobin↓ White cell count↑ or normal Platelets↑ or normal ESR↑

16. CRP (C reactive protein)↑ Gamma globulins(immunoglobulins)↑ Albumin↓ Alkaline phosphatase (ALP)↑ Iron and TIBC↓ Ferretin↑

17. WHICH INFLAMMATORY JOINT DISEASE?

18. COMMON MODES of PRESENTATION of RHEUMATIC DISEASES SYSTEMIC POLYARTICULAR MONO / OLIGOARTICULAR AXIAL

19. ACUTE CHRONIC

20. JOINT FLUID White cell count Examination for crystals Culture and sensitivity

21. Multiple pathologies can coexist in the one joint

25. PATTERN OF JOINT INVOLVEMENT NON-JOINT MANIFESTATIONS

26. Pattern of Involvement In distributionsymmetrical or not small or large joints axial or peripheral many, few or single joint In timeepisodic flitting constant additive Associated extra-articular problems

27. Joints Skin Eyes Lymph nodes – spleen Lungs Kidneys

30. Rheumatoid Factor≠Rheumatoid arthritis ANA≠Systemic lupus HLA B27≠Ankylosing spondylitis High urate≠Gout

32. HLA B27 ANKYLOSYNG SPONDYLITIS90% NORMAL POPULATION 9%

38. BACK PAIN THAT IMPROVES WITH ACTIVITY CONSIDER THE POSSIBILITY of INFLAMMATORY SPONDYLARTHROPATHY

41. Rheumatoid arthritis: hands, advanced deformity (radiograph)

42. Klareskog L et al Arthritis Rheumatism 2006

47. Rheumatoid Arthritis Early intervention matters Smoking is a risk factor

48. Hypouricaemic therapy Can precipitate gout in the introductory phase of treatment & needs to be covered Do not stop because of breakthrough flare Treat to target serum urate level

49. Multiple pathologies can coexist in the one joint

54. REDNESS HEAT SWELLING PAIN LOSS OF FUNCTION

55. Tendinitis Enthesitis Fibrositis

57. DIAGNOSIS EVALUATION

64. SYSTEMIC

65. MONO or OLIGOARTICULAR

66. Rheumatoid Arthritis A systemic inflammatory disease of unknown cause, with a particular predilection to involve the synovium

67. Osteoarthritis A localised disease of joints, thought to arise as a consequence of cartilage degeneration

74. POLYARTICULAR

75. Basics of diagnosis by G Major