The Nature of Arthritis

	Location	Symmetrical	Pain	Deformity	Stiffness
SLE	Small joint of wrist and hand followed by knee	Assymetrical	Disporportionate to swelling	None except secondary to Jaccoudlike arthropathy	None
RA	3 or more joint. Usually start with small joint (PIP, MCP,MTP) but others also possible; wrist, elbow, knee, ankle	Symmetrical but may be assymetrical in small joint like PIP and MCP.	Pain	ulnar deviation, boutonnière and swan-neck deformities, hammer toes	Morning stiffness longer than 30 minutes
Gout	Usually 1 or 2 joint (90%), and involve small, lower extremities	Assymetrical	exquisitely tender especially during acute attack	Heberden and Bouchard node. Look also for tophi which are collections of urate crystals in the soft tissues	None
Osteoarthritis	Weight bearing joint like knee and pelvis. May also occur in vetebral joint	Depends.	Initially responds to analgesic but may be very painful. Except for severe OA, pain is relief by taking rest	Heberden and Bouchard node, varus deformity.	Morning stiffness less than 30 minutes, during rest and gradually better with activity (gel phenomena)
Juvenile RA	Oligoarticular disease (four or fever joints) typically larger joint especially knee. More than 5 joint affected in poly articular JRA.	Assymetry. Some may be symmetrical if involve small joint	Child refuse to walk or can walk with limping gait		Morning stiffness, or gelling phenomenon
Psoriatic arthritis	five pattern can be observed (assymetrical oligoarticular arthritis, symmetrical polyarthritis, distal interphalangeal arthropathy, arthritis mutilans, Spondylitis with or without sacroiliitis)	Assymetrical except for polyarthritis. Differentiate from RA with presence of DIP joint involvement.	Less severe than RA pain	Look for cutaneous sign which highly suggestive of Psoriatic arthritis. Cutaneous sign usually preceded the joint problem.