A comprehensive read for diagnosing Arthritis in simple manner !!
Joint pains is a common stay OPD diagnosis where patients range from young to older age group. The main symptoms patients come up with is usually Pain and Stiffness. Patients may have varying symptoms which also depend on type of arthritis that they have. Most commonly diagnosed amongst all is Osteo-arthritis or Degenerative arthritis. This is usually seen in elderly patients or young patients with history of trauma to the knee.
The typical patient complaints of a pain on the inside of the knee especially, restricted range of movements and inability to walk. The character of pain is often described as pricking, stabbing or throbbing which is described on weight bearing. Also, there is complaint of stiffness whenever the patient starts doing an activity after a period of rest. On the other hand patients of Rheumatoid arthritis complaint of many joint pains (poly-arthralgia) which usually includes the knee along with small joints of the hand and feet. The stiffness is typically seen in ‘morning’ hours which settles itself to some extent with the day.
Both diseases may have overlapping symptoms but few subtle differences always exist. The differences are enumerated in tabulated form for a quick exclusion.
|AGE: Usually >60 years. Young patients with post traumatic injury come early.||3rd to 5th decade usually|
|Symptoms: Pain large joints. Insidious onset.||Stiffness >Pain. Swelling, redness, temperature raised.|
|Involves: Large joints (m/c) Knee, Hip, Ankle, Thumb Joint etc.||Small joints usually affects hands, knees, elbow, wrists and Stiffness >> Pain. Stiffness is more after a period of rest.|
|Xrays :Loss of joint space. Bony outgrowth at margins (Osteophytes), Deposition of bone at joint margins (Osteoslcerosis).||Show loss of joint space. Loss of bone density around the joints (peri-articular Osteopenia).|
|Hematology: None Specific.||ESR, CRP, RA factor, Anti-CCP and Complete Haemogram indicate ongoing inflammatory process.|
|Treatment: Depends on stage of arthritis. grade 1,2,3 can be managed conservatively. Grade 4 is usually managed with surgical intervention.||Control of Rhematoid ArthritisActivity & symptomatic treatment depending on stage.|
The decision making completely depends on the presentation of symptoms and diagnosis of the patient. The cases who present early on with worse symptoms have poorer prognosis as compared to the patients presenting with milder symptoms in elderly age group. The response to treatment always remains questionable till the diagnosis is accurate. Most patients presenting with grade 1, 2 and 3 arthritis are started on conservative form of treatment initially, failing which, surgical treatment is sought.
Wide array of surgical options are available and vary from realignment surgeries (High tibial Osteotomy, Proximal Fibular osteotomy) to Knee replacement in degenerative arthritis. The treatment of Rheumatoid Arthritis is focused on control of active disease and symptoms along with a low threshold for replacement surgery.
People suffering with pain and swelling should get diagnosed early on for better prognosis and relief of symptoms. It is imperative to start with rehabilitation and exercises once acute symptoms settle down for prevention of recurrence of pain.