Inflammatory Joint

Symptoms

• Morning stiffness lasting >1 hour

• Stiffness worsening after inactivity, easing with movement

• Fatigue, weight loss possible

• Possible rash (lupus, psoriatic arthritis)

• Low-grade fever or sweats in some cases

Examination Findings

• Joint swelling (often symmetrical in rheumatoid arthritis)

• Erythema, tenderness, warmth over affected joints

• Reduced range of motion or deformity (chronic/advanced disease)

Investigations

Blood Tests

• ESR/CRP: Elevated in active inflammation

• Anaemia of chronic disease (normocytic) or microcytic (less common)

• RF (Rheumatoid Factor): Positive in ~70% of RA, but not specific

• Anti-CCP: More specific for RA

• ANA: Consider if suspicion of lupus or other connective tissue disease

Imaging

• X-rays: Erosions, joint space narrowing, periarticular osteopenia in chronic RA

• Ultrasound/MRI: Can detect early synovitis, erosions, or enthesitis

Differentials

• Autoimmune: Rheumatoid arthritis (RA), psoriatic arthritis, lupus (SLE), ankylosing spondylitis

• Infectious:

  • Septic arthritis (urgent aspiration required)

  • Viral arthritis (e.g. parvovirus, hepatitis B/C)

• Crystal Arthropathies:

  • Gout (urate crystals)

  • Pseudogout (calcium pyrophosphate)

• Reactive Arthritis: Post-GI or GU infections

Management

Non-Pharmacological

• Joint mobilisation and strengthening exercises

• Joint protection strategies (splints, ergonomic tools)

• Low-impact exercises (e.g. swimming, yoga) to maintain flexibility

• Lifestyle: Balanced diet, healthy weight, smoking cessation

Pharmacological

• NSAIDs (e.g. ibuprofen, naproxen) for symptom control

• DMARDs (Disease-Modifying Anti-Rheumatic Drugs) for RA/psoriatic arthritis:

  • Methotrexate or sulfasalazine as first-line

  • Hydroxychloroquine, leflunomide also options

• Corticosteroids: Oral or intra-articular for acute flare-ups

• Biologic Therapies: e.g. TNF-alpha inhibitors, for DMARD-refractory cases

Specific Treatments

1. Septic Arthritis

   • Emergency joint aspiration + IV antibiotics (e.g. flucloxacillin, cefazolin)

   • Tailor antibiotics to culture results

2. Gout

   • Acute: Colchicine, NSAIDs (e.g. indomethacin), or steroids if contraindications to NSAIDs

   • Recurrent: Urate-lowering therapy (allopurinol or febuxostat)

3. Pseudogout (Calcium Pyrophosphate Deposition Disease, CPPD)

   • NSAIDs or intra-articular steroids for acute flares

4. Enthesitis-Related Conditions (e.g. ankylosing spondylitis)

   • NSAIDs, physiotherapy, biologics if severe

Regular Monitoring

• Evaluate disease activity (e.g. DAS28 for RA)

• Repeat blood tests (CRP, ESR) and imaging to assess treatment response and identify complications early

• Ongoing collaboration with rheumatology if moderate–severe disease or poor prognostic factors