About Physiatry

Inflammatory Arthritides

Condition: Inflammatory arthritides are inflammatory diseases that affect the joints and related structures. Conditions include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), gout, pseudo-gout, ankylosing spondylitis (AS), psoriatic arthritis (PsA), gonorrhea, tuberculosis, and osteomyelitis.

Background: The causes of many of these conditions are unknown, although inflammation and autoimmunity are important factors and may run in families. Bacteria, fungi, and viruses cause infectious forms of arthritis.

Risk Factors: Inflammatory arthritides affect all age groups. RA affects more women than men and more people of European descent with a peak age of 25 to 50 years. SLE occurs more often in African Americans, and 90% of patients are female. PsA and AS are more common in younger populations.

History and Symptoms: Joint swelling and pain occurs and most often develops gradually for all inflammatory arthritides conditions. RA presents with disease in small joints (such as the fingers, hands and wrists) and progresses to disease in large joints (such as knees, shoulders and hips). RA patients may also often present with serious systemic issues such as upper neck dislocation, heart disease, kidney problems, and inflammation of the blood vessels. Inflammatory back pain suggests AS, and disease symptoms in the ends of the fingers or toes and skin plaques suggest PsA. Rashes are symptoms of SLE and Lyme disease.

Physical Exam: A thorough physical exam will be performed to examine all joints for pain, swelling, deformities, range of motion, and strength as well as mobility and activities of daily life. Onset and duration of pain as well as involvement of other organs will also be noted.

Diagnostic Process: Laboratory blood tests can be used to examine certain factors, such as complete blood count, rheumatoid factor, and specific autoantibodies. X-rays can be used to document severity and disease progression. MRI is useful for assessing the joints, muscles, and soft tissues, and ultrasound is used for imaging of motion of specific joints. Joint fluid analysis can be used to aid diagnosis of inflammatory versus non-inflammatory arthridites and of infectious arthritis. Inserting a small scope into the joint enables doctors to look into the joint.

Rehab Management: The primary goal of treatment is the absence of symptoms. Non-steroidal anti-inflammatory drugs (NSAIDS) are good for controlling pain and inflammation, although these drugs do not alter disease course. Other medications, including immunosuppressive drugs, biologic agents, and immune-targeting drugs, are effective alone and/or in combination for disease control. Rehabilitation involves joint support and protection, strengthening, stretching, and range of motion exercises. Aquatic therapy is especially helpful, and heat and cold can be used to decrease pain and stiffness. Joint replacement surgery is recommended in severe cases and may require inpatient rehabilitation.

Other Resources for Patients and Families: Patient education and self-management programs are beneficial, reduce pain, and minimize healthcare costs. The American College of Rheumatology website (http://www.rheumatology.org) contains considerable patient information. Counseling is important for learning coping strategies.


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