A brief guide to help you distinguish between inflammatory and non-inflammatory arthritis in UKLME MCQs.
Inflammatory Arthritis
Inflammatory arthritis will present with:
Joints which have pain, stiffness and swelling.
- Symptoms worse at rest
- Symptoms get better with activity
- Symptoms worst in the morning
- Stiffness which lasts over 30 mins
There are many different types of inflammatory arthritis, these include but are not limited to rheumatoid arthritis, psoriatic arthritis and reactive arthritis .
Rheumatoid arthritis
Typically affects the small joints in the hands and feet in a symmetrical fashion. Joints often affected are MCP joints, PIP joints, the wrist and MTP joints. Systemic symptoms include fatigue, weight loss, flu-like symptoms and muscles aches. Extra-articular manifestations include pulmonary fibrosis, carpal tunnel syndrome and episleritis and scleritis. Associated with rheumatoid factor and anti-CCP antibodies. Treatment includes the use of DMARDs such as methotrexate, leflunomide or sulfasalazine. More resistant cases are eligible for biologic therapies such as TNF inhibitors and Anti-CD20 medications.
Psoriatic arthritis
Inflammatory arthritis associated with psoriasis. There are multiple disease patterns, it can present with both symmetrical and asymmetrical disease. It can involve the DIP joints and axial skeleton which distinguishes it from rheumatoid arthritis. Other key features include nail pitting, onchylosis, dactylitis and enthesitis (inflammation of the points where tendons insert into bones). Management coordinated by dermatologists and rheumatologists.
Reactive arthritis
Hot, swollen joint triggered by infection e.g. chylamydia or gastroenteritis (e.g. campylobacter). Most commonly affects the knee. Other symptoms include bilateral conjunctivitis, anterior uveitis, urethritis. Treatment includes NSAIDs and most cases resolve within 6 months. Associated with HLA B27 gene.
Non-inflammatory arthritisÂ
Will present with: joint pain and stiffness which is better with rest and worse with activity.
- Bulky, bony enlargement of the joint
- Restricted range of movement
- Crepitus on joint movements
- Effusions (fluid) around the joint
Joints commonly affected: cervical spine, hips, lumbar spine, DIP joints, knees and CMC joint at the thumb base.
X-ray changes:
L- loss of joint space
O- osteophytes
S- subchondral cysts
S- subarticular sclerosis
Management: exercises to improve strength and function, weight loss and occupation therapy to support activities and function e.g. adaptations for the home. Topical NSAIDs are first-line, the use of PO steroids co-prescribed with PPI for gastroprotection can be considered if topical therapy does not provide therapeutic effect.
References
- https://zerotofinals.com/medicine/rheumatology/ra/
- https://www.passmedicine.com/menu.php?revise=all
- https://www.uptodate.com
- https://www.versusarthritis.org/mskstudyguide
