Types of Arthritis

Arthritis is a commonly misused term. Pain in a joint is known as arthralgia whereas swelling of a joint is known as arthritis. Arthritis is a symptom and not a disease. Arthritis can occur in various diseases just as fever can occur in malaria, flu, typhoid, TB and urinary infection. There are over 100 causes of arthritis. It is a common clinical problem and a proper diagnosis of underlying condition requires a systematic approach.

Some of the patterns of arthritis are mentioned below:

  1. Arthralgia - Pain in a joint does not necessarily mean swelling. Pain without swelling usually involves many joints at the same time and may not always have an organic cause.
  2. Periarticular Pain - Pain can also arise from structures around the joints such as muscles, tendons, ligaments and bursae. Frozen shoulder, tennis elbow and housemaid’s knees are some examples of such conditions. These are known as soft tissue rheumatism and generally classified under regional pain. Pain occurs during active movement but not if someone else moves the joint. Repetitive trauma (occupational or overuse) or acute overexertion usually leads to such problems
  3. Swollen Joint - A joint with swelling of synovium can be warm and reddish. It feels boggy or rubbery and is tender to touch. Movements are generally restricted leading to stiffness. Non-inflammatory swelling is firm and may be tender along joint line. Joints can be deformed and accompanied by wasting of adjoining muscles due to prolonged restriction of movements.
  4. Inflammatory Pain - It is extremely important to identify an inflamed joint at the earliest as inflammation of swollen synovium causes irreversible damage to cartilage and other structures within the joint. Morning stiffness of more than 30 minutes, relief pf pain by movements and exercise, spontaneous relapses and remissions are some of the important features of an inflamed joint. Laboratory investigations can also help in identifying inflammation. Inflammatory arthritis occurs in conditions such as rheumatoid and other autoimmune arthritis, spondarthritis, septic arthritis and gout.
  5. Monoarthritis and Polyarthritis - Involvement of a single joint is common in septic arthritis, gout, osteoarthritis and some other types. Simultaneous or additive involvement of many joints is typical in conditions such as rheumatoid arthritis and Chikungunya arthritis.
  6. Symmetry Of Joint Involvement - Polyarthritis can be symmetric or asymmetric. Symmetric joint involvement is observed in rheumatoid arthritis and other inflammatory autoimmune diseases. It can also occur in metabolic arthropathies, primary generalized osteoarthritis, viral arthritis and some other conditions. Asymmetric joint involvement is characteristic of spondarthritides such as ankylosing spondylitis.
  7. Acute - Sudden onset of joint pain and swelling is characteristic of conditions such as gout, reactive arthritis, viral arthritis, septic arthritis, sarcoid arthritis and bleeding disorders. Examination of joint fluid is essential in conditions such as gout and septic arthritis especially when a single joint is swollen. Arthritis of more than 6 week duration is called as chronic arthritis. Rheumatoid arthritis, osteoarthritis and spondarthritides are examples of chronic arthritis.
  8. Association With Systemic Features - Elaborate history and a detailed clinical examination are extremely important in the diagnosis of arthritis. Diseases such as systemic lupus erythematosus, vasculitis, scleroderma, Sjogren’s syndrome, sarcoidosis, tuberculosis, leprosy, AIDS and cancer affect different organ systems including joints. These diseases need to be identified properly so that appropriate treatment can be initiated. Fever, hair loss, weight loss, fatigue, loss of appetite, diarrhea, breathlessness, eye pain and redness, dryness of eyes and mouth, enlargement of liver and spleen, lymph nodes in neck and other areas are some of the features that indicate systemic involvement alongwith arthritis.
  9. Childhood Arthritis - Arthritis in children less than 16 year old is a distinct disease with several subtypes. Rheumatic fever, characterized by fever, fleeting joint pains, heart valve defects and other features, is also common in children. There are over 100 diseases that can lead to musculoskeletal complaints in children. Sports injuries, infections, inflammatory arthritis, tumours, metabolic syndromes like rickets, congenital diseases and psychosomatic causes can cause joint pains in children.


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