The Nature of Arthritis 2

	Location	Symmetrical	Pain	Deformity	Stiffness
Septic arthritis	Anywhere. Could be monoarticular and could be polyarticular too. History of predisposing infection play a role	Nil	Acute onset tenderness. Beware of partially treated septic arthritis which could be painless	Swollen joint with effusion. Look for deformity due to RA as it may preceed the septic arthritis	Nil
Rheumatic fever	multiple large joints, play attention on migratory joint pain	Nil	Painful but responds rapidly to aspirin	Rare but may have Jaccoud arthritis	Nil
Reactive arthritis	Peripheral joint involvement commonly weight bearing joint. small joint of hand and feet may involve in chronic and severe cases	Assymetry	Acute onset, tolerable	Nil	Nil
Dengue fever	Non specific, usually involve whole joint. More of Arthralgia	Nil	Tolerable, responds well with analgesic	Nil	Nil
Chikugunya	Non specific. May involve all joint More of Arthralgia	Nil	Severe and disabling patient. May persist even after the disease being treated	Nil	Nil

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.