10/24/2025
🦴 Arthritides: A Comprehensive Overview
▪️ Arthritides encompass various conditions characterized by joint damage.
▪️ This damage can arise from several different underlying processes, including mechanical stress over time, trauma, crystal deposition, primary joint inflammation, or primary joint infection.
▪️ A healthy articular joint, such as the hip or knee, is composed of two bony surfaces lined with hyaline cartilage and surrounded by a joint capsule.
▪️ The joint capsule is lined by a thin synovial membrane.
▪️ These joints typically move freely and painlessly due to the smooth surfaces of articular cartilage and the lubricating properties of the synovial fluid.
👉
🧩 Key Concepts in Distinguishing Arthritides
▪️ When evaluating arthritis, it is crucial to differentiate between inflammatory and mechanical joint pain.
▪️ Inflammatory joint pain: Most pronounced in the morning, improves with activity but returns after rest, with morning stiffness typically lasting more than one hour.
▪️ Mechanical joint pain: Typically worse with activity, improves with rest, and morning stiffness tends to resolve within 30 minutes.
▪️ Additional diagnostic features include duration of symptoms, number and size of joints involved, symmetry, pattern of onset (episodic or migratory), and axial involvement (spine or sacroiliac joints).
👉
🗂️ Classification of Arthritic Conditions
▪️ Acute Monoarthritis: Septic arthritis, acute crystalline arthritis (gout, pseudogout/acute CPPD), trauma.
▪️ Acute Polyarthritis: Viral infections (Parvovirus B19, Hepatitis B/C, HIV), atypical systemic autoimmune disease (RA, SLE).
▪️ Chronic Noninflammatory: Osteoarthritis, osteonecrosis, neuropathic arthritis, meniscal/ligament/tendon derangements.
▪️ Chronic Inflammatory: Rheumatoid arthritis, Systemic Lupus Erythematosus, Tophaceous gout, Spondyloarthropathy (Psoriatic arthritis, Ankylosing spondylitis).
👉
🧫 Diagnostic Essentials: Synovial Fluid Analysis
▪️ Acute joint pain and swelling lasting less than two weeks require rapid workup including synovial fluid analysis (cell count, differential, crystal analysis, Gram stain, and cultures) to evaluate for bacterial infection.
▪️ Septic arthritis can cause rapid joint damage and may be life-threatening if untreated.
▪️ Synovial fluid analysis classifies arthritis as normal, noninflammatory, inflammatory, or septic, based on white blood cell count, clarity, and viscosity.
🩻 Detailed Overview of Specific Arthritides
👇
1️⃣ Osteoarthritis (OA)
▪️ Most common form of chronic noninflammatory arthritis.
▪️ Pathology: Cartilage loss exposes underlying bone, activating pain and sensory nerve endings in the subchondral bone.
▪️ Cause: Mechanical stresses over time or previous trauma.
▪️ Joints Affected: Hips, knees, and first MTP joint; first CMC, DIPs, and PIPs in upper extremity.
▪️ Clinical Features: Pain worse with use and relieved by rest; stiffness improves within 30 minutes; joints rarely warm to touch.
▪️ Imaging: Joint space narrowing, osteophytes, joint line sclerosis, subchondral cysts.
▪️ Treatment: Weight loss, activity modification, physical therapy, acetaminophen, NSAIDs, topical diclofenac, intra-articular steroid injections.
📃 Physiotherapy Relevance:
▪️ Central to OA management—focuses on strengthening periarticular muscles, improving joint mobility, reducing pain, and optimizing function through individualized exercise programs, gait retraining, and education on load management.
2️⃣ Acute Crystalline Arthropathies (Gout and Pseudogout)
▪️ Result from precipitation of crystals in or around joints, presenting with acute flares.
▪️ Clinical Features: Warm, swollen, and exquisitely painful joints; podagra (first MTP involvement); tophi in chronic gout.
▪️ Imaging: Gout shows nonmarginal erosions with overhanging edges (“rat bite lesions”); pseudogout shows chondrocalcinosis in knee or wrist cartilage.
▪️ Diagnosis: Synovial fluid microscopy—gout crystals are needle-shaped with bright negative birefringence; CPPD crystals are rhomboid with faint positive birefringence.
▪️ Treatment: NSAIDs, corticosteroids, or colchicine for acute flares.
📃Physiotherapy Relevance:
▪️ Vital post-acute phase to restore mobility, maintain range of motion, and prevent stiffness.
▪️ Education on joint protection, gradual strengthening, and avoidance of mechanical overload supports long-term joint health.
3️⃣ Rheumatoid Arthritis (RA)
▪️ Systemic autoimmune condition presenting with inflammatory arthritis.
▪️ Epidemiology: Affects 1% of population, more common in women (3:1).
▪️ Pattern: Gradual, symmetrical onset involving wrists, MCPs, and MTPs; spares DIPs.
▪️ Features: Warm, swollen joints; MCP subluxation, boutonniere, and swan neck deformities in advanced stages.
▪️ Imaging: Soft-tissue swelling, periarticular osteopenia, uniform joint space narrowing, marginal erosions; C1–C2 involvement may cause atlantoaxial instability.
▪️ Diagnosis: Rheumatoid Factor and anti-CCP antibody testing.
▪️ Treatment: Rheumatology referral; DMARDs (methotrexate or leflunomide) are first-line.
📃Physiotherapy Relevance:
▪️ Essential for maintaining joint range, function, and muscle strength.
▪️ Programs emphasize gentle mobility exercises, energy conservation, hand function training, and splinting during active disease to prevent deformities.
4️⃣ Systemic Lupus Erythematosus (SLE)
▪️ Multisystem autoimmune disorder affecting joints, skin, kidneys, and blood.
▪️ Joint Involvement: Nonerosive; Jaccoud arthropathy causes reducible ulnar deviation and swan neck deformities.
▪️ Diagnosis: ANA test highly sensitive.
▪️ Treatment: Hydroxychloroquine and systemic steroids; avascular necrosis may occur in hips, knees, or shoulders.
📃 Physiotherapy Relevance:
▪️ Focuses on maintaining mobility and minimizing pain in nonerosive joints.
▪️ Low-impact aerobic and strengthening exercises help preserve function and reduce fatigue associated with systemic disease.
5️⃣ Psoriatic Arthritis (PsA)
▪️ Inflammatory spondyloarthropathy with possible axial involvement.
▪️ Pathology: Enthesitis— inflammation at tendon or ligament insertions.
▪️ Joints Affected: Common in patients with psoriasis; often involves DIPs in hands and feet.
▪️ Imaging: Pencil-in-cup deformity in severe disease.
▪️ Treatment: Similar to RA; systemic steroids avoided due to rebound flare risk.
📃 Physiotherapy Relevance:
▪️ Targets flexibility, posture correction, and management of enthesitis-related pain.
▪️ Exercise therapy enhances joint stability, while hydrotherapy and education reduce stiffness and fatigue.
6️⃣ Reactive Arthritis (ReA)
▪️ Occurs after infections such as urethritis (Chlamydia) or enterocolitis (Campylobacter).
▪️ Joints Affected: Larger joints—knees, ankles.
▪️ Other Findings: Conjunctivitis and psoriaform rash (keratoderma blennorrhagia).
▪️ Treatment: Usually self-limited; managed with NSAIDs or, in persistent cases, DMARDs (sulfasalazine).
📃Physiotherapy Relevance:
▪️ Rehabilitation aids recovery through range-of-motion and progressive strengthening exercises.
▪️ Prevents stiffness and supports return to function once acute inflammation resolves.
7️⃣ Lyme Arthritis
▪️ Inflammatory arthritis secondary to Borrelia burgdorferi infection.
▪️ Joints Affected: Weight-bearing joints, especially knees; often migratory.
▪️ Diagnosis: Lyme serologies and synovial fluid PCR.
▪️ Treatment: 28 days of doxycycline (adults) or amoxicillin (children/pregnant women).
📃 Physiotherapy Relevance:
▪️ Crucial after antibiotic treatment to address residual joint pain, stiffness, and weakness.
▪️ Emphasizes strengthening, proprioceptive training, and gait retraining to restore full function.
