Joint health inflammation -
Surgery is rarely needed in the early stages of inflammatory arthritis but can be considered in patients with chronic deformities due to underlying chronic autoimmune inflammatory arthropathies such as rheumatoid arthritis.
An interprofessional team approach, including patient education, physical and occupational therapy, diet, and lifestyle modification, can significantly improve patient outcomes.
It is of importance to differentiate inflammatory from noninflammatory arthritis. The most common form of non-inflammatory arthritis is osteoarthritis which usually has an insidious onset and gradually worsens. Typical joints involved in primary osteoarthritis include the knees, hips, lumbar spine, 1st metatarsophalangeal joints in the feet, proximal and distal interphalangeal joints in the hands, and 1st carpometacarpal joint in the wrist.
Repetitive use or injuries can lead to the involvement of other joints as well, such as the shoulders, elbows, ankles, and wrists. It can be symmetric or non-symmetric. Bony hypertrophy changes can be palpable on the exam, especially in the hands and feet. The joint can be tender and swollen, but erythema or warmth is usually absent.
Synovial fluid analysis reveals noninflammatory fluid. Radiographs can show characteristic osteoarthritic changes with loss of joint space and osteophytes.
Erosions are rare, but central "gull-wing" erosions can be seen in erosive osteoarthritis of the hands involving the proximal and distal interphalangeal joints.
Prognosis depends on the cause of arthritis. If treated early and appropriately, acute inflammatory arthropathies such as septic arthritis or crystal-induced arthritis have an excellent prognosis.
Delay in treatment or misdiagnosis can lead to erosions and permanent joint damage, which can be aggressive, especially in septic arthritis. In patients with rheumatoid arthritis or seronegative spondyloarthritis, early and aggressive treatment can prevent long-term complications such as erosions and joint deformities.
The prognosis of inflammatory arthritis associated with underlying connective tissue disorders depends on the underlying disorder. Complications in septic arthritis arise from delay in treatment or mass diagnosis, possibly leading to aggressive and permanent joint damage.
Chronic gout, rheumatoid arthritis, and seronegative spondyloarthritis can be associated with erosive changes and joint damage, which can interfere with daily function. Patients with crystalline arthropathies such as gout require education regarding diet and lifestyle modification which can help manage gout.
Patients with chronic inflammatory arthropathies frequently need long-term immunosuppressive medications. They need counseling about the potential benefits and adverse effects of these medications and the necessity for regular monitoring laboratory workups.
Finally, they should also understand the importance of regular exercises. An interprofessional team approach is indicated for best outcomes in patients with inflammatory arthritis.
In patients with septic arthritis, multi-specialty evaluation with internal medicine, orthopedics, rheumatology, and infectious diseases may be needed. For patients with other autoimmune inflammatory arthropathies, close communication between the rheumatologist and primary care provider is of utmost importance.
Further, pharmacists can assist in patient education about medications, and the nursing team can assist in ensuring patient compliance. Physical therapy and occupational therapy frequently play a key role in helping the patients maintain the full range of the function of the joints and encouraging them to exercise and lose weight.
Disclosure: Pooja Poudel declares no relevant financial relationships with ineligible companies. Disclosure: Amandeep Goyal declares no relevant financial relationships with ineligible companies. Disclosure: Sarah Lappin declares no relevant financial relationships with ineligible companies.
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-. Search term. Inflammatory Arthritis Pooja Poudel ; Amandeep Goyal ; Sarah L. Author Information and Affiliations Authors Pooja Poudel 1 ; Amandeep Goyal 2 ; Sarah L.
Affiliations 1 Suny Upstate Medical University. Continuing Education Activity Inflammatory arthritis includes a group of arthritis accompanied by joint pain, swelling, warmth, and tenderness in the joints, and morning stiffness that lasts for an hour.
Introduction Arthritis is defined as "painful inflammation and stiffness of the joints. Etiology Etiologies of inflammatory arthritis include: Infectious or septic arthritis: Organisms causing infectious arthritis include Staphylococcus aureus , Streptococcal pneumoniae , Neisseria gonorrhea , anaerobic bacteria, mycobacteria species, brucellosis, Borrelia burgdorferi , sporotrichosis, coccidioidomycosis, viruses Parvovirus , Enterovirus , and Rubella.
Autoimmune inflammatory arthritis: This is a broad category that can be further divided into several categories: Rheumatoid arthritis - seropositive or seronegative. Seronegative spondyloarthritis - This family of HLA-B27 associated arthropathies includes psoriatic arthritis, ankylosing spondylitis, reactive arthritis, arthritis associated with inflammatory bowel disease, and non-radiographic spondyloarthritis.
Arthritis associated with underlying connective tissue or autoimmune diseases - arthritis is a common clinical manifestation of several rheumatic and autoimmune diseases such as: Systemic lupus erythematosus.
Arthritis associated with malignancy - Inflammatory arthritis can be a frequent paraneoplastic phenomenon associated with underlying malignancies.
Palmar fasciitis and polyarthritis PFPA syndrome - frequently associated with ovarian cancer but can be seen in association with any malignancy. Epidemiology The annual incidence of early inflammatory arthritis ranges from to per , adults, and the incidence of undifferentiated inflammatory arthritis UA ranges from 41 to per , adults.
Pathophysiology Pathophysiology is distinct and different based on the underlying etiology of inflammatory arthritis. History and Physical While there is a significant overlap, most inflammatory arthropathies can be classified based on history and physical examination.
Evaluation Laboratories Elevation in inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein are frequently seen in all inflammatory arthropathies.
Synovial Fluid Analysis Aspiration of the synovial fluid and detailed analysis is critical in the evaluation of inflammatory arthritis. Imaging Plain radiographs may be initially normal in early inflammatory arthritis or may show periarticular osteopenia.
Differential Diagnosis It is of importance to differentiate inflammatory from noninflammatory arthritis. Prognosis Prognosis depends on the cause of arthritis.
Complications Complications in septic arthritis arise from delay in treatment or mass diagnosis, possibly leading to aggressive and permanent joint damage. Deterrence and Patient Education Patients with crystalline arthropathies such as gout require education regarding diet and lifestyle modification which can help manage gout.
Enhancing Healthcare Team Outcomes An interprofessional team approach is indicated for best outcomes in patients with inflammatory arthritis. Review Questions Access free multiple choice questions on this topic.
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Copyright © , StatPearls Publishing LLC. Bookshelf ID: NBK PMID: PubReader Print View Cite this Page Poudel P, Goyal A, Lappin SL. Inflammatory Arthritis. In: StatPearls [Internet]. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones.
Other autoimmune diseases can cause inflammatory arthritis as a symptom. Examples include Sjogrens syndrome and lupus. If you have inflammatory arthritis, it is imperative that you see a rheumatologist on a regular basis to monitor your health and customize your treatment.
Rheumatologists are medical doctors with special training in the care of people with joint diseases and autoimmune diseases. They are different from orthopedists, who are trained in surgery and who may also be involved in the care of people with inflammatory arthritis when medical treatments are not enough.
How do you know whether to start with a rheumatologist or orthopedist? If you have ongoing joint discomfort without chronic swelling or other symptoms, such as fatigue, you may be able to see an orthopedist first.
But if your joint pain is accompanied by warmth, swelling, other signs of inflammation, fatigue or discomfort in other parts of your body, a visit to a rheumatologist may be in order. Your primary care physician can guide you. Because inflammatory arthritis is an autoimmune disease that can affect multiple parts of your body, you may need to see other specialists, too, to keep your symptoms in check and maintain the best quality of life possible.
Your rheumatologist may choose from a variety of treatment options for inflammatory arthritis, depending on the type and severity of your disease, such as:.
A diagnosis of inflammatory arthritis can initially feel overwhelming. It can take weeks or even months to come to terms with and understand what having this disease can mean in your life.
By developing a close working relationship with your rheumatologist and other caregivers, however, there is much you can do to control inflammatory arthritis and maintain an independent and active lifestyle.
If you or someone you know is living with a chronic inflammatory condition, learn about the different patient support programs available at HSS. Living with Inflammatory Arthritis: What You Need to Know. By ; Vivian P. Bykerk, BSc, MD, FRCPC.
What is inflammatory arthritis? Inflammatory arthritis vs. osteoarthritis Types of inflammatory arthritis You and your rheumatologist: A lifetime partnership. Body parts, tests and causes Inflammatory arthritis Osteoarthritis Parts of body affected A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skin Symptoms are limited to the joints Positive biomarker tests Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein CRP , and erythrocyte sedimentation rate ESR on blood tests Blood tests for biomarkers are negative Causes Autoimmune disease related to body-wide inflammation Mechanical wear-and-tear on joints due to age or injury.
Vivian P. Bykerk, BSc, MD, FRCPC Director, Inflammatory Arthritis Center of Excellence Associate Attending Rheumatologist, Hospital for Special Surgery.
Inflammatory Arthritis Treatment: What's Working, What's Coming COVID and Inflammatory Arthritis: What You Should Know The Best Diet for Inflammatory Arthritis Exercise and other Complementary Therapies for Inflammatory Arthritis Pain Inflammatory Arthritis in Children: More than Growing Pains.
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