Symptoms

• Joint pain and swelling

• Early morning and inactivity stiffness > 30 minutes

Risk factors / Demographic

• Age

  • >50

    • Calcium Pyrophosphate Deposition Disease

    • OA

    • Polymyalgia Rheumatica

  • <50

    • Gout

    • OA

    • SLE

    • Scleroderma

    • Reactive Arthrtitis

• Gender

  • Male

    • Gout

    • Reactive Arthritis

    • Ankylosing Spondylitis

  • Female

    • RA

    • Connective Tissue Disorders

Timing

• Acute

  • Viral or reactive

  • Gout of Pseudogout

  • Septic Arthritis

• Slow

  • RA

  • Connective Tissue

  • Spondyloarthropathies

Affected Joints

• RA

  • Can start oligo

  • Progresses to bilateral symmetrical MCP, PIP, Carpal, MTP

• Connective Tissue

  • Symmetrical or migratory

  • Fingers, wrists, knees

• Crystal

  • Mono-articular

Other

• Viral illness = viral arthritis

• Pharyngitis = Rheumatic fever

• Gut, eyes, lungs and genitals in reactive arthritis

• Eyes = Spondyloarthropathy, Behcet’s, Sjogren’s

• Back pain, tendinopathy and enthesitis = Spondylarthropathies

• Skin = Psoriasis, SLE, Scleroderma

• Raynauds, skin, pleuritis, pericarditis, fevers, chills = SLE or scleroderma

• Constitutional = Septic arthritis, PMR, RA

Tests

• Persistent joint swelling for more than 6 weeks

• FBC, UEC, CRP/ESR, LFT, RF, Anti-CCP

• Urinalysis

• Urate if gout suspected

• ANA, dsDNA, ENA if CT disorder suspected

• Consider HLAB27

• STD checks

• A Basic guide to autoimmune testing: ANA ENA dsDNA