Inflammatory Joint Disease
Is a chronic syndrome characterized by nonspecific, usually symmetric inflammation of the peripheral joints, potentially resulting in progressive destruction of articular and peri-articular structures. It's associated with systemic disturbance, a variety of extra-articular features and the presence of circulating anti-globulin antibodies [rheumatoid factor.]
Atiology is unknown. The immunologic changes may be initiated by multiple factors. About 1% of all populations are affected, women 2-3 times more than men. Onset may be at any age especially 25 - 50 years.
Most commonly onset is insidious,
- With progressive pain,
- Stiffness and symmetrical swelling of peripheral joints, especially small hand joints [proximal IP gives spindle appearance and meta-carpophalangeal],
- Feet [metatarsophalangeal joints - results in broadening of the forefoot],
- Wrists, elbows, shoulders, knees and ankles.
- Other joints occassionally affected are:
- sternoclavicular and
- Stiffness lasting > 30 minutes on rising in the morning or after inactivity is common;
- Early afternoon fatigue and malaise occur.
Progression of the disease
Progress of the disease causes :
- muscle atrophy, tendon sheath and joint destruction which result limitation of joint motion,
- joint instability, subluxation and deformities.
These include flexion contractures of
- hands, feet, knees, hips and elbows.
- Ulnar deviation of the fingers [anterior subluxation of the metacarpo-phalangeal joints;
- Swan neck deformity [hyperextension of proximal IP joint with fixed flexion at the distal IP joint and extension of the terminal IP joint].
- Deformity of the thumb.
- Clawing of the toes also occur. Subcutaneous rheumatoid nodules are seen at sites of pressure or friction
- Sjogren's syndrome is the association of xerostomia and keratoconjunctivitis sicca with a connective tissue disorder.
Extra-articular features are:
|| Weight loss, Fatigue, Susceptibility to infection.
||Muscle wasting, tenosynovitis, bursitis, osteoporosis
||Anaemia, throbocytosis, eosinohilia [ESR raised]
||Lymphadenopathy, splenomegaly, Felty's syndrome [association
of splenomegally and neutropaenia with RA]
||Episcleritis, scleritis, scleromalacia, kerato-conjunctivitis sicca
||Ulcers, digital arteritis, visceral arteritis
||Peri-, myo-, endocarditis, conduction defects, vasculitis, aortitis
||Nodules, pleural effusions, fibrosing alveolitis, bronchiolitis
||Cervical cord compression, compression neuropathies, peripheral neuropathy
Septic arthritis can occur in patients with longstanding nodular seropositive disease.
This is one of the clinical features of inflammatory arthritis of 6 weeks duration
Criteria for Classification of Rheumatoid Arthritis
Any four criteria must be present to diagnose Rheumatoid Arthritis. The first four criteria must have been present for 6 weeks.
- Morning stiffness for > 1 hour
- Arthritis or > 3 joint areas
- Arthritis of hand joints [wrist, metacarpophalangeal or proximal interphalangeal joints]
- Symmetric arthritis
- Rheumatoid nodules
- Serum rheumatoid factor
- Radiographic changes.
- Patient treated with drugs. Allopathically drugs are: Intra-articular corticosteroid injections, NSAID, Simple analgesics and slow acting anti-rheumatic drugs.
- Recommend surgery
- Directed towards relief of symptoms
- Consideration taken to the active and progressive disease
- Conservation and restoration of function in affected joints
- Recommend - rest, physiotherapy
- If need be - will refer patient for surgery
- Patient treated with homoeopathic medication and/or Isotherapy.