There is an old joke. Not so: “Neurologists diagnose intractable, whereas the treatment of Undiagnosed rheumatologists. Nothing could be truer than when it comes to what is called “inflammatory arthritis”.
Most rheumatologists arthritis tend to divide into two broad categories: inflammatory and non-inflammatory. The latter category is also called “degenerative” arthritis.
The main distinction is that the types of inflammatory arthritis have a significant amount of inflammatory cells that attack the joints. These types of arthritis tend to cause more symptoms, including stiffness and pain. They also tend to be progressive. Often the types of inflammatory arthritis are associated with constitutional symptoms, ie, low grade fever, weight loss and fatigue. Types of inflammatory arthritis can also cause significant damage to internal organs. Disability and early death may be a consequence of some types of inflammatory arthritis. Examples of inflammatory arthritis are rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, gout, infectious arthritis, and ankylosing spondylitis.
Types of inflammatory arthritis can strike at any age.
Types of inflammatory arthritis are typical patterns, although in theory any joint in the body can be affected.
Forms of inflammatory arthritis may not be easy to classify. Sometimes it will be apparent that inflammation is present and is a component of the symptom complex. However, a specific diagnosis may not be apparent. Eventually most forms of inflammatory arthritis to “declare” and eventually fall into a category. But not always! This is a situation where an expert in clinical diagnosis and is worth its weight in gold!
Moreover, non-inflammatory forms of arthritis cause symptoms on the basis of mechanical factors. Often, degenerative arthritis affecting weight-bearing joints such as neck, lower back, hips and knees. Tends to occur in older people. While it may progress, it does so relatively slowly. It is rarely, if ever, associated with constitutional symptoms. In fact, if the constitutional symptoms are present, then the patient has no more inflammatory arthritis or another disease in addition to their arthritis. This is the type of arthritis is often associated with people age.
Not the types of inflammatory arthritis can be confusing at times. One example is that fibromyalgia is a condition where the pain is almost everything. Symptomatic and subjective joint swelling can make clinical diagnosis difficult.
The distinction between inflammatory and non-inflammatory arthritis is based on a careful history, physical examination, laboratory tests and imaging such as magnetic resonance imaging (MRI) and ultrasound.
Sometimes a patient can have both types of arthritis. For example, it is not uncommon for a patient with longstanding rheumatoid arthritis to have degenerative arthritis (osteoarthritis) in a knee or hip.
Interestingly, when an arthroscope (a small telescope) is used to visualize the inside of a whole, almost all types of arthritis have an inflammatory component to them. The degree and rate of inflammatory disease, although it varies with the disease.
The treatment for inflammatory arthritis may vary. While anti-inflammatory drugs are sometimes useful, it may be necessary to initiate therapy with disease modifying drugs. Once again the skill and experience of arthritis specialist is paramount in determining the direction to head. Obviously, if inflammatory arthritis is well defined, then the treatment becomes easier to define as well.
The key point to remember is that if you have arthritis, it is important to seek the opinion of an expert specialist in arthritis.