Arthritis - Inflammation of the joints causes stiffness, swelling and pain in affected joints.
Arthritis is inflammation of one or more joints (respectively mono- and polyarthritis), either large joints (knees, hips, shoulders, elbows) or small joints (fingers, toes, jaw joints). "Synovitis" actually describes the rheumatic inflammation that can be seen in a tissue sample (biopsy) from the inside of an arthritic joint. In practice, the word "synovitis" is also used for joint inflammation / arthritis. In Norwegian, we distinguish arthritis from Osteoarthrtitis (English: osteoarthritis). Osteoarthritis is often called "wear-and-tear arthritis" and has a lower degree of inflammation than arthritis. Arthritis should also not be confused with joint pain (arthralgia) which does not cause swelling and increased heat over the joints. Most forms of arthritis are caused by a autoimmune attack from our own immune system. The triggering cause is most often unknown. Septic (infectious) arthritis is caused by infection, most often bacteria.
Symptoms of arthritis - inflamed joints
Joint pain (arthralgia) and stiffness can be the beginning of arthritis, but within a few days swelling and increased heat over the joint will most often occur. Affected joints usually also have reduced mobility, so that they cannot be bent or stretched completely. Often a new tiredness or tiredness is felt throughout the body and some people experience night sweats and a little fever. Arthritis can come on acutely, within a few hours, especially with gout, chondrocalcinosis / pyrophosphate arthritis, reactive arthritis og infectious / septic arthritis. In such cases, redness is often seen over affected joints.
Examinations in arthritis
Medical history maps current symptoms (see above) and dispositions (closest relatives), but also whether there have been signs of previous other disease such as infections of the throat, lungs, gastrointestinal tract, urinary tract or insect / tick bite, rash (Psoriasis) and intestinal disorders (IBD arthritis). Travel abroad, especially in remote areas in recent months, is also of interest (see also the chapter on tropical diseases).
At clinical examination especially affected the affected joints, but also the head, neck, lungs, heart, stomach area, skin and nervous system.
Blood tests includes "inflammatory tests" such as CRP and lowering reaction (ESR), platelets, red and white blood cells, liver, kidney and metabolism / thyroid tests and uric acid. "Rheumatism tests" may consist of anti-CCP (arthritis / rheumatoid arthritis), ANA (connective tissue diseases), ANCA (some types of vasculitis) and among the genetic factors HLA-B27 (reactive arthritis, Ankylosing spondylitis / Bekhterev disease). Borrelia antibody is measured on suspicion Lyme disease infection. In case of fever and signs of serious infection, the cultivation of bacteria in the blood may be relevant (blood cultures).
Urine sticks should always be considered.
Imaging is most often done with Ultrasound of affected joints. If necessary, supplement with X-ray or MRI examination of joints. X-ray or CT of the lungs in case of suspected disease manifestations also there (Sarcoidosis).
Puncture and of swollen joints and examination of the synovial fluid is often done when large joints such as knees, ankles, hips, shoulders, elbows and wrists are attacked.
A combination of medical history, clinical examination and blood tests will usually be sufficient for the diagnosis. Imaging and sometimes puncture of joints can be done to confirm the diagnosis (see above).
Treatment of arthritis
Acute arthritis treated with painkillers such as paracetamol or NSAIDS (Ibux, Naproxen, Voltaren, etc.). If swollen joints are present, joint puncture and cortisone injection can have both a soothing and long-term effect. Cortisone tablets in the form of prednisolone can be used for the shortest possible period.
In chronic arthritis are immunosuppressive drugs to prevent the development of joint damage and complications from other organs relevant. Initially can prednisolone and / or joint punctures may be relevant. Joint drainage of joint fluid and joint injection with a cortisone drug are often used for knees and other large joints. In chronic arthritis diseases such as Rheumatoid arthritis (RA), SLE and similar conditions are often complementary Methotrexate tablets or injections. If the disease is still active, the treatment can be supplemented with "biological drugs".
Arthritic Diseases (Arthritis)
Adult Stills disease. High and variable fever, arthritis, rash with fever, high ferritin in blood test
Childhood arthritis (juvenile arthritis). A separate group of chronic diseases among children of all ages (but can continue into adulthood)
Connective tissue diseases. Arthritis is also common Systemic connective tissue diseases:
Ankylosing spondylitis (Ankylosing spondylitis). Chronic back pain, most evident in the morning, minor symptoms after physical activity. Can also cause arthritis, most often in the hip and knee joints. Some people also have chronic inflammation of the intestines (Ulcerative colitis or Crohn's disease). More about rheumatic manifestations of chronic inflammatory bowel disease here . About 25% get eye inflammation (uveitis, iridocyclitis). Ankylosing spondylitis is detected by radiological examination of «sacroiliac joints» between the pelvis and spine.
Familiar Mediterranean Fever (FMF). Ethnic from the Mediterranean countries and North Africa, family history. Acute self-limiting seizures with arthritis and inflammation in pericardium og lung membranes / serocyte).
- Borrelia arthritis (Lyme disease) is a special form of septic arthritis that can attack the knee or other joints a few weeks or months after tick bite. The fewest tick bites lead to infection. If a tick has sucked blood for a long time, it increases the risk of infection
- Septic arthritis caused by infection (mostly bacteria)
- Whippel's disease (arthritis can precede other symptoms for several years)
- Immunological checkpoint inhibitors (provisional anti PD-1 such as pembrolizumab and nivolumab and anti PDL-1 such as atezolizumab, avelumab and durvalumab) are effective against several types of cancer. However, they increase risk of autoimmune disease that Rheumatoid arthritis (RA) og Polymyalgia rheumatica (PMR) (Reference: Belkhir R, 2017). Separate page on rheumatic side effects of checkpoint inhibitors here
- BCG treatment against urinary bladder cancer can cause joint pain and arthritis (arthritis), usually 2-4 weeks after treatment. Knees and ankles are most often attacked. The symptoms usually last for 6 months
- Granulocyte and granulocyte macrophage colony stimulating factor (G-CSF / GM-CSF) is used as a supplement for some chemotherapy. The treatment may lead to acute, symmetrical arthritis in several joints. Symptoms usually occur within a few days after the end of treatment.
Arthritis / Rheumatoid Arthritis (RA). Symptoms lasting two weeks or more. Swollen fingers / toes. Difficult to tie hands, especially in the morning. The feeling of "walking on pillows", especially in the morning. Blood tests with increased CRP, rheumatoid factor (RF) and anti-CCP.
Reactive arthritis. Severe inflammation of large joints (knees, ankles and hips). Begins a few weeks after infection, often chlamydia, yersinia, salmonella or campylobacter- bacteria (from the urinary tract or intestines). Knee joints are most often attacked. Eye disorders (uveitis, iridocyclite) occur.
Intestinal inflammation, chronic, IBD. Ulcerative colitis or Crohn's disease (chronic intestinal inflammation). Most often arthritis in the knees and / or ankles and in active intestinal inflammation.
Vasculitis diseases, systemic can cause arthritis, although other manifestations are more prominent.
- GPA (Wegener's granulomatosis)
- Takayasu arteritis
- Giant cell arteritis (temporal arteritis)
- Behcet's disease
- Relapsing polychondritis
Gout. Caused by uric acid crystals.
Referral to rheumatologist
If arthritis - arthritis is suspected - the GP usually chooses to refer to rheumatologist or rheumatology department after preliminary examinations (assessment of affected joints, blood and urine samples) have been done.