Questions
2–3 questions per professional paper
Difficulty
Medium
Importance
High yield for University theory and clinical viva
Overview
Arthritis encompasses a diverse group of disorders characterized by joint inflammation, pain, and stiffness, serving as a cornerstone topic in clinical orthopedics and pathology. Mastering these distinctions is vital for both theoretical exams and clinical viva, as it requires correlating underlying pathophysiology with distinct clinical presentations.
Osteoarthritis (OA)
OA is a degenerative joint disease characterized by the progressive loss of articular cartilage and secondary reactive changes in the subchondral bone. It is primarily a 'wear and tear' condition common in weight-bearing joints of elderly patients.
- Pathology: Fibrillation and fissuring of articular cartilage
- Clinical: Heberden's and Bouchard's nodes
- Imaging: Joint space narrowing, subchondral sclerosis, and osteophytes
- Aggravating factors: Activity-related pain relieved by rest
- Morning stiffness duration: Usually less than 30 minutes
Rheumatoid Arthritis (RA)
RA is a systemic autoimmune disease characterized by chronic, symmetrical polyarthritis and the formation of a destructive pannus. Unlike OA, it involves synovial inflammation that can lead to joint deformity and systemic involvement.
- Pathophysiology: Type III hypersensitivity, synovitis, pannus formation
- Clinical: Symmetrical small joint involvement (MCP, PIP joints)
- Deformities: Boutonniere and Swan-neck deformity
- Serology: Positive Rheumatoid Factor (RF) and Anti-CCP antibodies
- Morning stiffness duration: Usually greater than 1 hour
Gouty and Septic Arthritis
Gout is a crystal-induced arthropathy caused by monosodium urate monohydrate crystal deposition due to hyperuricemia. Septic arthritis is a medical emergency caused by direct microbial invasion, requiring immediate diagnosis to prevent permanent cartilage destruction.
- Gout: Podagra (first MTP joint involvement)
- Gout: Negative birefringent needle-shaped crystals on joint aspiration
- Septic: Fever, extreme pain, and restricted joint movement
- Septic: Synovial fluid analysis shows high leukocyte count (>50,000 cells/mm3)
- Management: Septic arthritis requires urgent surgical drainage and antibiotics
Exam Tip
Always contrast OA and RA using the 'S.T.A.R.' framework: Symmetry, Type of joint, Associated symptoms, and Radiographic findings.
Common Mistakes
- Confusing the morning stiffness duration between OA and RA.
- Failing to mention the presence of systemic symptoms in RA compared to the localized nature of OA.
- Neglecting to emphasize the urgency of septic arthritis as a potential medical emergency.
More Revision Notes
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