Achilles Tendon Pain

Posts Tagged ‘Arthritis’

Injuries like ankle fracture and severe sprain may possibly result in ankle arthritis because of gradual loss of cartilage lining a couple of years after the injury. In some people who are suffering from ankle arthritis, their condition is related to other diseases like diabetes and hemophilia.

You will find different tests for diagnosing ankle arthritis. Doctors usually base it about the patient’s report or by looking at the X-ray of the ankle. They occasionally need the patient to undergo MRI or a CT scan.

Nowadays, they can figure out the exact area of the loss of cartilage by injecting air and dye inside the ankle. In this way, specialists can see the cartilage problem in three dimensional pictures less than one millimeter in size.

There are lots of ways of treating ankle arthritis, like the following below:

1. Medical Remedy-The main objective in treating ankle arthritis is to reduce the joint inflammation. Anti-inflammatory medicines like Ibuprofen, Celebrex, Naprosen and Vioxx are typically used. These medicines are prescribed by doctors depending on the patient’s allergies, medical history and reaction to the remedy. The doctor may possibly also suggest weight loss along with medication. Specialists have determined that losing weight can cut down stress on the ankle when standing or walking.

2. Orthotic Management-Braces and inserts can help in managing ankle arthritis. Proper selection of these instruments is based on insight place of the cartilage loss, walking and standing mechanics of the patient and other medical issues. An ankle brace can reduce anxiety on the foot that is affected with arthritis and, occasionally, removes the requirement of surgery.

3. Physical Treatment-Physical therapy can decrease the symptoms of ankle arthritis by utilizing diverse techniques that concentrates about the affected ankle. Patient’s can perform flexibility exercises or may also undergo pool and aquatic therapy. This could also keep the patient fit with out the risks of further injuries to the joint of the ankle. Therapists may also teach patients how to properly use canes to decrease anxiety on the ankle.

4. Injections-Injection of steroid for the ankle can enhance the inflammation of the joint. Nevertheless, this therapy is delicate so patients for steroid injection are carefully tested.

5. Ankle Arthritis Surgery-Surgery for ankle arthritis depends on several factors like the following below:

Cartilage loss location

The patient’s weight, age and the level of activity

The patient’s skin, tendons, nerves and bone around the ankle

Medical history, allergies and reactions to previous treatments

Ankle arthritis could be controlled making use of various methods so if you’re suffering from this ailment, it’s a good idea that you consult a specialist to know what treatment is best for you.

About four weeks ago my right knee started hurting and I thought maybe I had sprained it…mostly a dull ache but with stabbing pain in the middle of my knee cap (felt like it was under the knee cap) the pain was similar to the tendonitis I have in both wrists (mostly my right) however over the last week my left knee has started doing the same thing and now my ankles too. The past three days my knees,ankles and wrists have been constantly aching! Its about put me in tears at some points. Is this arthritis? I am only 23, is my doctor going to think I am being stupid?

I am nearly 17 and have had bad knees and ankles for over 3 years and have now developed pain in nearly every joint in my body. could I have arthritis? I know it is possible for teens to develop arthritis but I just can’t tell if I have. I can crack every one of my joints (neck, elbows, shoulders, knees, ankles, wrists, fingers, toes, back, hips, and jaw). Could I have tendonitis or arthritis or neither?HELP!! I am also very stressed out with my lifestyle. I have not been as physically active until now. I used to ride horses but quit and developed more joint pain and am now afraid to go back to riding. I am also in dance but my joints prevent me from thoroughly enjoying myself. Please help me!!!!
I am nearly 17 and have had bad knees and ankles for over 3 years and have now developed pain in nearly every joint in my body. could I have arthritis? I know it is possible for teens to develop arthritis but I just can’t tell if I have. I can crack every one of my joints (neck, elbows, shoulders, knees, ankles, wrists, fingers, toes, back, hips, and jaw). Could I have tendonitis or arthritis or neither?HELP!! I am also very stressed out with my lifestyle. I have not been as physically active until now. I used to ride horses but quit and developed more joint pain and am now afraid to go back to riding. I am also in dance but my joints prevent me from thoroughly enjoying myself. Please help me!!!!

I drink soda very rarely and am very thin and lightweight for those who made comments relative to those factors.
I drink soda very rarely and am very thin and lightweight for those who made comments relative to those factors.
Sorry! I screwed up with the details! oops.

Six months ago I was in a car crash. I broke my lateral malleolus on my fibula and my medial malleolus on my tibia.
http://academic.wsc.edu/faculty/jatodd1/351/tibia_fibula.jpg

It turns out that my lateral malleolus-the end of my fibia-and my medial malleolus-the end of my tibia-connects to my ankle joint.
http://www.allaboutarthritis.com/image/stock_image/ankle_bones_MMG.jpg

On top of all this, I have tendonitis in my heel. Everytime I walk my lateral malleolus area aches SO bad. Can I already have arthritis is my ankle joint even thought its been six months?

Ive been taking Tylenol Arthritis pain 650mg acetaminophen. Anything else else that can help with this pain?

Thanks
Is it ok to be taking tylenol everyday

I have come across this all natural product that I was seriously considering asking my doctor about, but I have only one question, is it only for arthritis, or just joint inflamation/pain in general? From like dance or sports….

because i have developed tendonitis in my ankles and knees and my back has been hurting me beyond imaginable. As a matter of fact, all my joints hurt including my fingers and toes, but i was tested for both lyme and arthritis and both came out negative, so i dunno….

any suggestions or inputs are welcome! Thanks you!

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The Ultimate 7-Day Natural Remedy for Arthritis, Gout, and Rheumatism

Maybe pain occurs, like when trying to open a jar. What’s it all about? Let’s look at the basics and learn more.

Arthritis actually means “joint inflammation” and has over 100 related conditions or type / forms of disease. Left untreated, it can advance, resulting in joint damage that cannot be undone or reversed. So early detection and treatment are important.

The two most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). Although both have similar symptoms, both happen for different reasons. When joints are overused and misused, the results can be OA. What happens is that the cushioning cartilage that protects the joint breaks down, resulting in the bones rubbing together. This generally happens in the knees, but can be found in the hips, spine and hands often, too. And only in later stages will a person most often feel pain, after quite a bit of cartilage is lost.

The second type, RA, refers to the body’s immune system attacking joint tissue. Still not fully understood in the medical community, this condition most often starts in a person’s hands, wrists and feet. Then it advances to shoulders, elbows and hips.

Similar symptoms include pain, stiffness, fatigue, weakness, slight fever and inflamed tissue lumps under the skin. And both OA and RA generally develop symmetrically, i.e. affecting the same joints on both the left and right sides of the body.

A difference in OA and RA to note is with swelling. With RA, people report “soft and squishy” swelling. While with OA, people report “hard and bony” swelling. Another difference is that a person is more likely to develop RA if a sibling or parent had it. While a person with a history of joint damage, either an injury or chronic strain, runs a higher risk for developing OA.

There is no specific age for arthritis sufferers. While it can affect every age group, it seems to focus on those over 45 years of age.And while neither gender is immune, a reported 74 percent of OA cases (or just over 15 million) occur with women and a slightly lower percentage of RA cases occur with women. People with excess weight tend to develop OA, especially in the knees when reaching over 45 years of age. However, losing weight can turn the odds around almost by half. Regular activity combined with exercise also reduces risk, strengthening joint muscles and reducing joint wear.

Although there are no cure-alls for arthritis, there are a variety of pain relief treatment strategies. Aside from medications, remedies, replacement alternatives and other helpful treatment options and alternatives, the four main arthritis relief aids are gentle exercise, good nutrition, a positive attitude and rest. And each will be discussed further in subsequent sections, because education can play a huge role to dispel “old wives tales” and myths that “nothing can be done about arthritis.” Notable is that today, only a small percentage of those afflicted with arthritis become crippled. And most never need canes, wheelchairs, or other ambulatory devices.

Also note if you suspect you may have arthritis, it is advisable to seek medical advice. Because healthcare providers can help to determine if the symptoms are not something else like a virus or tendonitis or other similar problem that cold potentially worsen if left untreated.

Types Of Arthritis

There are many ways to effectively manage arthritic pain today to find relief. Available are arthritic diets, exercise programs, over-the-counter and prescription medications, relaxation and positive emotion coping techniques. Also available are surgeries, supplements, home remedies, natural and other alternative therapies. When arthritis is first suspected, it would be wise to seek a medical opinion first. Then as time and resources allow, check out the other options.

After osteoarthritis (OA) and rheumatoid arthritis (RA), three other major types of arthritis are systemic lupus erythematosis, ankylosing spondylitis and gout. Let’s take a look at each:

Systemic Lupus Erythematosis (SLE) – This form of arthritis mainly affects women. It develops in the skin, internal organs and joints.

Ankylosing Spondylitis – This form or arthritis affects the spine and can also affect the ankles, knees, lungs, heart, shoulders and eyes.

Gout – This is a painful affliction mainly for men, about one million of them in the United States alone. Uric acid build up, due to an internal chemical malfunction, forms crystals that get stuck in a joint, generally the big toe, and become inflamed.

Science Of Arthritis

Joints can handle some heavy pressure. For example, knees handle a force of three to four times a person’s total body weight on average just talking a walk. The force of a deep knee bend during a squat can increase to nine times the body weight. So just imagine multiplying weight of more than 150 pounds times a minimum of three or four, and then even more. That can sure add up to a lot of heavy work on knee joints over time.

Now for the science of this scenario. Where two bones meet, called the joint, the bone ends are covered with cartilage, also known as gristl

This cartilage is sturdy, elastic and spongy or compressible, and keeps the bones from moving against each other at the joint. The cells of this cartilage, called chondrocytes, are thought to be the longest living cells of the body. Surrounding the bones and cartilage is strong, fibrous capsule lined with synovium, a thin membrane that lubricates the joint area with fluid. The end result is less friction or smoother rubbing together of the bones. This fluid also feds the cartilage cells, keeping them healthy, and is “pumped” into them during joint movement. Thus lack of movement (activity / exercise) can be unhealthy.

Other parts of the body features involved with this arthritic scenario include muscles, tendons, ligaments, bursea and mental activity. Muscles, attached to bones with tendons and ligaments, move bones by contracting. They also cushion movement, absorbing impact or shock. Throughout the muscle and tendon areas are bursae or sacs filled with fluid. These also help cushion movement. And throughout all the coordination of these parts during movement, the brain is a part. The brain communicates via nerves throughout the body, in particular the muscles for this scenario, to prepare joints for activity.

The exact science of what actually causes arthritis is still being researched. For most of the 100-plus forms of arthritis, the causes are unknown. Injury, overuse of joints and mechanical issues with joints (like skeletal abnormalities, worn out joint muscles) can lead to arthritis. And many point to issues relating to bacteria and germs as some of the problem. Heredity, stress, drugs, food allergies and viruses have also been linked to some forms of arthritis. So have diet, poor circulation and lack of movement.

INFLAMMATION
Arthritic joints can be affected with inflammation when bacteria or a virus (or other undesirable element) enters the joint area or when an injury occurs. What happens is when foreign matter enters this area or the area sustains injury, white blood cells, antibodies and other natural “fighting” mechanisms automatically kick in internally to help. These fighters cause swelling, redness and heat as the body fluid moves around. Symptoms of inflammation, one of the uncomfortable issues associated with arthritis, are redness, swelling and tender joints.

Arthritis is plainly described as the inflammation of the joints that connects the bones in the body. In order to cure arthritis, one must know what causes arthritis because every situation differs.

Some people wonder what are the causes because any person may be affected by this ailment regardless of age and the built of the body. The cause may either be genetics, age, weight, previous injury.

Genetics is one of the main causes of arthritis. When it runs in the family, it is possible to have the problem even if the person is still young. It is considered hereditary when from the very beginning one’s cartilage, joints, tendons, or muscles are weak and brittle.

Another cause is one’s age. Normally, young people should not experience arthritis; it should be felt only by persons over 50 years of age because at this age, the cartilage becomes weaker and can no longer repair itself. Another instance of weak cartilage is because of its failure to absorb nutrients from the body. As a person grows older it is expected that he or she may develop it.

Weight is also a cause. The weight referred to here is being overweight that the joints in the body are having a hard time supporting the excess body weight. This cause generally affects the hips, knees, and the ankles. If the body is quite heavy than the average or the required weight in terms of age, it is expected that the hips, knees and ankles will be forced to carry the heavy weight and in effect, damaging the joints, cartilage, and tendons.

Previous injury is likewise a cause of arthritis. This happens when a bone is broken and it affects the cartilage. An example of a previous injury is the tibial plateau fracture. In this injury, the part of the bone fractured affects the cartilage of the knee joint.

Other causes include occupational hazards, high-level sports, and illness or infection. With respect to occupational hazards, it causes arthritis because of the nature of the work performed. This is true with respect to construction workers, or other occupation that requires heavy lifting and activities. This cause is similar to overweight. High-level sports can cause a problem because of overuse or putting so much tension on the bones of the body. But do not be misled, sports are good for the body, however, if one overuses his body, it may cause injury, and thereafter, a possible arthritis. It may also be cause by illness or infection; the classic examples are septic joint infection, multiple incidents of gout, and other medical condition that affects the muscles, joints, bones, cartilage, and tendons.

Determining what causes arthritis is a very big problem when the ailment is already at its worst stage. It may be suffered by a person only after it has developed throughout the years without us knowing, or maybe it is due to old age. As such, one must be careful and cautious of any pain he may experience, no matter how insignificant it may be. Asking a doctor for an opinion at an early stage may lead to the easy determination of the cause and the proper remedy for it.

Over 100 known forms of arthritis are making millions of people suffer today. The most weakening of all forms is rheumatoid arthritis. Rheumatoid Arthritis Symptoms are joints that ache, throb, and eventually become deformed. Those who suffer from rheumatoid arthritis symptoms often find it hard to do everyday tasks, like taking a walk, or opening a car or jar. Some with rheumatoid arthritis have joints that are so deformed they are unable to even do the simplest job. No one knows what causes rheumatoid arthritis, but many believe it is the body’s immune system attacking the lining of your joints. This lining called the synovium.

Rheumatoid Arthritis Symptoms are more common in women than in men and will usually strike an adult between the ages of 20 to 50. That is the general criteria for rheumatoid arthritis symptom sufferers, but people over 50 and children can also be affected.

Rheumatoid arthritis symptoms usually develop in several joints at the same time. The first parts of your body that show signs of rheumatoid arthritis symptoms are usually your wrists, shoulders, hands, and feet. As the rheumatoid arthritis symptoms gradually get worse, it will attack the elbows, hips, neck, and jaw as well. It normally affects both sides at the same time.

Rheumatoid arthritis symptoms may appear as small lumps under skin where there are pressure points near your elbows, hands, feet, and Achilles tendons. Rheumatoid arthritis symptoms can develop in other areas of your body, but that’s where they start. At some point, you may experience rheumatoid nodules on the back of your scalp, around your knees, and even in your lungs. Rheumatoid arthritis symptoms can develop your salivary glands, linings of your lungs and heart, and sometimes the tear duct glands. These lumps are usually not painful. They can be the size of a pea or the size of a walnut.

Here are some symptoms of rheumatoid arthritis. Some of those Rheumatoid arthritis symptoms are:

Aching and stiffness of joints and muscles, especially after a time of rest. Pain and swelling in the joints, especially the smaller ones like in the hand. Loss of motion in the joints. Low-grade fever. Strength is lost in the muscles attached to the affected joints. Chronic fatigue when there is a flare-up of the disease. Deformity of joints. A general sense of just not feeling well. Unable to pinpoint exactly why they feel bad.

Any or all of these rheumatoid arthritis symptoms may come and go, but largely depend on what type of activity you are taking part in.

Rheumatoid arthritis symptoms do not go away, but it does come in “episodes.” A person suffering from rheumatoid arthritis symptoms may go into remission for a period, and then have another flare up of pain, swelling, weakness, and difficulty sleeping. You may experience a flare up, and then have several weeks or months of remission before it attacks again. There isn’t any reason why a person suffering from rheumatoid arthritis symptoms can’t be productive and useful lives while working around the attacks of your rheumatoid arthritis.

Some researchers theorize that rheumatoid arthritis could be the result of an infection or inflammation. When your body experiences an infection or inflammation, it sends white blood cells through the bloodstream and attacks the lining of the joints. Their usual job is to attack bacteria and viruses in the body instead it attacks the lining of the joints.

Other risk factors can increase your chances of having rheumatoid arthritis. Risk is increased as you age. The good news is if you are over the age of 80, the risk decreases.

You also have a higher risk of having rheumatoid arthritis if you are a woman, and if you have been exposed to a virus or bacteria. Although the disease is not inherited, there is evidence that specific genes you inherit could make you more prone to this arthritis.

Last, smoking cigarettes over a many years can also increase your chances of rheumatoid arthritis.

There isn’t a cure for rheumatoid arthritis yet. Scientists and researchers are still searching for the cause when that is found hopefully a cure would follow.

With the proper treatment, change in lifestyles, and a plan to prevent joints from deforming, a person experiencing rheumatoid arthritis symptoms may still be able to live a productive and long life. Deformity or swelling may limit your flexibility, but even in the most severe form of rheumatoid arthritis, you will probably still keep flexibility in most of your joints.

There are more than 100 different kinds of arthritis. Most of them involve inflammation. When a patient goes to a rheumatologist to get a diagnosis, there is a process of elimination in order to arrive at the proper diagnosis. This process of elimination is called “differential diagnosis.”

Differential diagnosis can be a difficult undertaking because so many forms of arthritis, particularly inflammatory forms of arthritis look alike. The following is a list of types of inflammatory arthritis that can be seen and must be considered when evaluating a patient with inflammatory symptoms of arthritis.

Rheumatoid Arthritis (RA)

RA is an chronic, autoimmune, inflammatory disease, that may affect any joint in the body but preferentially attacks the peripheral joints (fingers, wrists, elbows, shoulders, hips, knees, ankles, and feet. It can also affect non-joint organ systems such as the lung, eye, skin, and cardiovascular system. The onset of RA may be insidious-slow- with nonspecific symptoms, including fatigue, malaise, loss of appetite, low-grade fever, weight loss, and vague aches and pains, or it may have an abrupt onset with inflammation involving multiple joints. The joint symptoms usually occur bilaterally and are symmetric. Damage to joints- called “erosions” can be seen with magnetic resonance imaging early on or by x-ray later in the course of disease. Approximately 80% of patients with RA will have elevated levels of rheumatoid factor (RF) or anti-CCP antibodies.

Juvenile Rheumatoid Arthritis (JRA)

JRA describes a group of arthritic conditions that occur in children under the age of 16. Three forms of JRA exist, including oligoarticular (1-4 joints), polyarticular (> 4 joints), and systemic-onset or Still’s disease. The latter is associated with significant internal organ involvement and may also present with fever and rash in addition to joint disease. Polyarticular JRA is considered to be the type that is most similar to adult RA, and is responsible for approximately 30% of cases of JRA. Most children with polyarticular JRA are negative for RF and their prognosis is usually good. Roughly, 20% of polyarticular JRA patients will have elevated RF, and these patients appear to be at more risk for chronic, progressive joint destruction and damage. Uveitis- an inflammatory condition of the eye- is a common finding in oligoarticular JRA, especially in patients who are antinuclear antibody (ANA) positive. The dangerous feature of uveitis is that it can cause relatively few symptoms so careful screening is recommended in order to avoid blindness.

Systemic Lupus Erythematosus (SLE)

SLE is a chronic inflammatory autoimmune disorder that can involve the skin, joints, kidneys, brain, and blood vessel walls. At least 4 of the following symptoms which have been formulated by the American College of Rheumatology are generally present for a diagnosis to be made:

• Red, butterfly-shaped rash on the face, affecting the cheeks;

• Typical skin rash on other parts of the body;

• Sensitivity to sunlight;

• Mouth sores;

• Joint inflammation (arthritis);

• Fluid around the lungs, heart, or other organs;

• Kidney dysfunction;

• Low white blood cell count, low red blood cell count due to hemolytic anemia, or low platelet count;

• Nerve or brain dysfunction;

• Positive results of a blood test for ANA; and

• Positive results of a blood test for antibodies to double-stranded DNA or other antibodies including anti-Smith antibodies or antiphospholipid antibodies.

Patients with lupus can have significant inflammatory arthritis. That is why lupus can be difficult to distinguish from RA, especially if other signs and symptoms of lupus are minimal.

Inflammatory Muscle Disease

Polymyositis (PM) and dermatomyositis (DM) are types of inflammatory muscle disease. These conditions typically present with bilateral (both sides) large muscle weakness. In the case of DM, rash can be a presenting sign. Diagnosis consists of four major features, including elevation of creatine kinase (CPK), signs and symptoms such as muscle weakness, elevated muscle enzymes (creatine kinase, aldolase), electromyograph (EMG) abnormalities, and a positive muscle biopsy. Often, laboratory test abnormalities can be seen including the presence of autoantibodies such antinuclear antibody (ANA), and the myositis-associated antibodies.

In both PM and DM, inflammatory arthritis can be present and can look like RA — including lung involvement. In RA, however, unless an overlap syndrome – ie., a patient having both RA as well as muscle disease) is present, muscle function should be normal. Also, in PM and DM, erosive joint disease is unlikely. RF and anti-CCP antibodies are typically elevated in RA and not PM or DM.

Spondyloarthropathies (SA)

A group of arthritic conditions called the spondyloarthropathies which include psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and enteropathic arthritis are a category of disease that cause inflammation throughout the entire body, particularly in parts of the spine and at other joints where tendons attach to bones. They also can cause pain and stiffness in the neck, upper and lower back, tendonitis, bursitis, heel pain, and fatigue. They are often called seronegative arthritis. The term ’seronegative’ means that tests for lab markers such as rheumatoid factor are negative. Symptoms of adult SA include:

• Back and/or joint pain;
• Morning stiffness;
• Tenderness near bones;
• Sores on the skin;
• Inflammation of the joints on both sides of the body;
• Skin or mouth ulcers;
• Rash on the bottom of the feet; and
• Eye inflammation.

In some cases of SA, peripheral arthritis resembling RA can be present. Careful history and physical examination can usually distinguish between these syndromes, especially if an obvious disease that is aggravating inflammation is present (psoriasis, inflammatory bowel disease). In addition, since RA rarely affects the end joints of the fingers (DIP joints), if these joints are involved from inflammatory arthritis, the diagnosis of an SA is favored. Usually, RF and anti-CCP antibodies are negative in SA, although in some cases of psoriatic arthritis there may be elevations of RF and anti-CCP antibodies.

Crystal Associated Arthritis

Monosodium Urate Disease (Gout)

Gout is due to deposition of monosodium urate crystals in a joint. Gouty arthritis is typically sudden in onset, very painful, with signs of significant inflammation on exam (red, warm, swollen joints). Gout can affect almost any joint in the body, but typically affects “cooler” regions including the toes, feet, ankles, knees, and hands. Diagnosis is made by withdrawing fluid from a joint and examining the fluid under a polarizing microscope. Patients may also have elevated serum levels of uric acid.

In most cases, gout is an acute disease that affects one joint and is easily distinguished from RA. However, in rare cases, chronic erosive inflammation can develop and affect multiple joints. And, in cases where tophi (deposits of uric acid under the skin) are present, it can be difficult to distinguish from erosive RA. However, crystal analysis of joints or tophi and blood tests should be helpful in distinguishing gout from RA.

Calcium Pyrophosphate Deposition Disease (CPPD; Pseudogout)

CPPD disease is caused by deposits of calcium pyrophosphate dehydrate crystals in a joint. The body’s reaction to these crystals, leads to significant inflammation. Diagnosis includes:

• Detailed medical history and physical exam;
• Withdrawing fluid from a joint using a needle;
• Joint x-rays to show crystals deposited on the cartilage (chondrocalcinosis);
• Blood tests to rule out other diseases (e.g., RA or osteoarthritis).

In most cases, CPPD arthritis presents with acute arthritis affecting one or more joints. However, in some cases, CPPD disease can present with chronic symmetric multiple joint erosive arthritis similar to RA. RA and CPPD disease can usually be distinguished by joint fluid examination demonstrating calcium pyrophosphate crystals, and by blood tests, including RF and anti-CCP antibodies, which should be negative in CCPD arthritis.

Sarcoid Arthritis

Sarcoidosis is an inflammatory type of arthritis. The majority of patients with this disease have lung disease, with eye and skin disease being the next most frequent signs of disease. In most cases, the diagnosis of sarcoidosis can be made on clinical and x-ray presentation alone. Patients will have acute arthritis, painful nodules under the skin on the shins (erythema nodosum), and a chest x-ray showing enlargement of lymph niodes. In some cases, the demonstration of a specific type of inflammation change, called a noncaseating granuloma on tissue biopsy, is necessary for definitive diagnosis.

Arthritis can be present in approximately 15% of patients with sarcoidosis, and in rare cases can be the only sign of disease. In acute sarcoid arthritis, joint disease is usually rapid in onset, symmetric, involving the ankle joints. The knees, wrists, and small joints of the hands can be involved. In most cases of acute disease, lung and skin disease are also present. Chronic sarcoid arthritis typically involves one or maybe a few joints and due to its often erosive nature can be difficult to distinguish from RA.

Polymyalgia Rheumatica (PMR) / Temporal Arthritis

PMR is a form of arthritis that leads to inflammation of tendons, muscles, ligaments, and tissues around the joints. It is characterized by large muscle (shoulders, hips, thighs, neck) pain, aching, morning stiffness, fatigue, and in some cases, fever. It can be associated with temporal arthritis/giant-cell arthritis (TA/GCA) which is a related but more serious condition in which inflammation of large blood vessels can lead to complications such as blindness, aneurysms and cramping pain in the arms or legs (limb claudication) due to inflammation and narrowing of the large blood vessels in the chest and extremities. PMR is diagnosed when the clinical picture is accompanied by elevated markers of inflammation (ESR and/or CRP). If temporal arthritis is suspected (headache, vision changes, limb claudication), biopsy of a temporal artery may be necessary to make the diagnosis.

PMR and TA/GCA can present with symmetric inflammatory arthritis similar to RA. These diseases can usually be distinguished by blood tests. In addition, headaches, acute vision changes, and large muscle pain are uncommon in RA, and if these are present, PMR and/or TA/GCA should be considered.

Infectious Arthritis

Many infections can present with arthritis either due to direct joint infection or due to autoimmune joint inflammation. In most cases, infections lead to acute single joint arthritis; however, in some cases, chronic arthritis affecting a few or many joints can be present. Because missed infections can lead to significant complications, it is crucial to have a high index of suspicion for infection in any patient presenting with acute or chronic arthritis.

Lyme disease

Lyme disease is an infection due to a type of bacteria called a spirochete. The disease is manifested by a skin rash, swollen joints and flu-like symptoms, caused from the bite of an infected tick. Symptoms may include:

• A skin rash, often resembling a bulls-eye (target lesion);
• Fever;
• Headache;
• Muscle pain;
• Stiff neck; and
• Swelling of knees and other large joints.

The diagnosis of Lyme disease is typically made by blood testing. If, however, chronic single joint arthritis develops, joint fluid analysis or joint tissue biopsy may be necessary for diagnosis. Lyme arthritis can usually be distinguished from RA by clinical presentation and blood tests.

Acute rheumatic fever (ARF)

Acute rheumatic fever is an inflammatory disease that may develop after an infection with the Streptococcus bacteria (strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain. Symptoms include:

• Fever;
• Joint pain;
• Arthritis (mainly in the knees, elbows, ankles, and wrists);
• Joint swelling; redness or warmth;
• Abdominal pain;
• Skin rash
• Skin nodules;
• A peculiar movement disorder (Sydenham’s chorea)
• Nosebleeds;
• Heart problems, which can be asymptomatic.

The diagnosis of ARF is made by clinical assessment and blood testing for antibodies against streptococcal proteins. ARF and RA can have similar clinical features including arthritis and nodules. However, ARF can usually be distinguished from RA by clinical presentation. Rash and migratory arthritis are unusual in RA. The use of blood tests is also helpful.

Viral arthritis (hepatitis B and C, parvovirus, EBV, HIV)

Arthritis may be a symptom of many viral illnesses. This makes viral infections a great masquerader. The duration is usually short, and it usually disappears on its own without any lasting effects. Clinical features in adults:

• Joint symptoms occur in up to 60%. These can be symmetric and affect the small joints of the hands, wrists, and ankles as well as the knees. Morning stiffness is also present.

• Parvovirus B19 is a very common viral infection that looks like RA.

• Diagnosis of viral arthritis is made by serologic testing. A high percentage of patients with hepatitis C may have elevated titers of RF. Therefore, RF testing is not helpful in distinguishing between hepatitis C infection and RA. However, in these situations, testing for anti-CCP can be helpful as anti-CCP antibodies have not been shown to be significantly elevated in isolated hepatitis C infections.

So as you can see… “it ain’t easy…”