This document discusses the approach and evaluation of arthritis. It outlines relevant factors to consider in a patient's history such as age, sex, family history, onset of symptoms, and pattern of joint involvement. It describes signs of inflammation seen in different types of arthritis and notes findings on examination of joints. Investigations that may be done including x-rays, blood tests, and synovial fluid analysis are also summarized. Treatment options are said to be based on diagnosis and may include medications, physical therapy, and surgery.

1. Approach to Arthritis
Diseases of joints

2. Evaluation
Joint involvement causes pain
Ensure joint involvement, and not
muscle or bone

3. Relevant history
 Age- young-RA, middle age-gout, old-OA
 Sex- male-SA, gout; female-RA, SLE
 F/H- may be +ve in SA, gout, RA, OA
 Onset- acute-gout, trauma, infection;
insidious-RA, OA
 Evolution- continuous-OA, intermittent-gout,
migratory-rheumatic fever, additive-Reiter’s
 Associated symptoms- fever, rash,
eye/GIT/GU involvement

4. Pattern of joint involvement
 Joints involved-
 Large-OA, small-RA
 Axial-SA, appendicular-RA
 Upper limb-RA, lower limb-gout
 Number of joints involved
 Mono- 1- traumatic, infectious
 Pauci- 2-4- gout, reactive arthritis
 Poly- >4- RA, SLE
 Symmetry
 Symmetrical- OA, RA, SA
 Asymmetrical- gout, trauma, infectious

5. Inflammation
 Causes pain, redness, swelling,
local temperature, ROM
 Inflammatory arthritides- RA
 Signs of inflammation
 Worst in morning
 Morning stiffness present
 Non-inflammatory arthritides- OA
 Pain & ROM
 Worst as day passes
 No morning stiffness

6. Examination
Inflammation
Crepitus
Range of movement
Deformity

7. Investigation
 X-ray of involved joint
 RA- periarticular erosions in hands/feet, soft tissue swelling
 OA- decreased joint space, loss of cartilage, osteophytes
 CBC, ESR, CRP
 Synovial fluid exam.
 Colour, protein, glucose
 WBC, gram stain, culture
 Crystals- polarised microscope
 Serology- ASO, RF, ANA
 CT scan/MRI

8. Treatment
Based on diagnosis
Paracetamol & NSAIDs
Physical/Occupational therapy

9. Low backache
A common problem

10. Types
 Local- steady dull pain, local
tenderness
 Referred- from viscera- abd./pelvic
 Radicular- restricted to territory of root
 Protective- muscle spasm

11. Pain
 Location
 Severity/intensity
 Onset & progression
 Character
 Aggravating & relieving factors
 Associated symptoms

12. Examination
 Inspection- deformity, asymmetry
 Palpation- tenderness
 Straight leg raising test or bending with
knees extended to elicit root pain
 Costovertebral tenderness
 Neuro. exam. of lower extremities
 Abdominal, PR/PV, peripheral vascular
examination

13. Investigation
 CBC, ESR
 Ca, PO4, alk. phosphatase
 PSA
 SPEP
 Bone-scan
 X-ray
 CT scan/MRI

14. PIVD
 L4-
 Pain & sensory loss in ant. thigh/knee
 DTR- knee absent
 L5-
 Pain hip, groin, posterolateral thigh, lateral calf, 1-3 toes
 Weakness of extensor of big toe
 Difficulty walking on heel
 DTR- normal
 S1-
 Pain posterior thigh, posterior calf, 4-5 toe
 Weakness of foot & toe flexors
 Difficulty walking on toes
 DTR-ankle absent

15. Treatment
Initially medical,
If not improved- MRI
Surgical based on MRI findings