Barry Fox - Arthritis For Dummies

Undifferentiated arthritis: This is the catchall category for various kinds of arthritis that don’t fit into any of the other categories, or belong to more than one category.

Regardless of the form JIA takes, it always causes joint stiffness, pain, and swelling that is usually worse upon awakening from a night’s sleep or even just a nap. Symptoms usually come and go. Sometimes a child may be lucky — the symptoms arise only a few times and then disappear forever — but a large percentage of children continue to have arthritis into adulthood. Luckily, most experience only mild forms.

To be considered JIA, the disease must produce joint inflammation and stiffness in at least one joint for at least six weeks in a person under the age of 17.

JIA is similar to adult rheumatoid arthritis, with a few key differences:

Many children with JIA outgrow the problem, while most adults with RA don’t.

JIA may affect bone development and growth in children, causing slow, rapid, or uneven growth in the afflicted joints.

Less than 50 percent of children with JIA test positive for rheumatoid arthritis factor, compared to 70 or 80 percent of adults.

Doctors diagnose and treat JIA in much the same way they do the adult version. But in addition to the medical treatment, children with JIA need special emotional and social support.

Infectious arthritis is caused by viruses, bacteria, or fungi that enter the body and settle into one or more joints. Depending upon which germs have invaded, they joint(s) they inhabit, the strength of the immune system, and the speed and accuracy of the treatment, a bout with infectious arthritis may be brief and relatively easy to take, or serious and painful.

Technically speaking, infectious arthritis is an infection of the joint tissues and/or fluid, or an autoimmune response to an infection in the joints. Several different germs, ranging from staphylococci to HIV to tuberculosis, can infect a joint or trigger an autoimmune inflammatory response in a joint.

With infectious arthrtitis, symptoms include joint pain to the touch or with movement, as well as swelling and stiffness. The skin around the joint may be red and puffy. If the infection spreads beyond the joint, a fever or other symptoms may accompany it (although fever can occur for other reasons). Some forms of infectious arthritis hit hard and fast, so it’s important that you see your doctor immediately if you have any symptoms. If left untreated, infectious arthritis may seriously damage joints within just a few days or weeks.

If your doctor suspects infectious arthritis, they will call for various tests to firm up the diagnosis. Blood, urine, and joint fluid samples will be analyzed for infectious organisms. But even before the lab results come back, your doctor may begin giving you antibiotics, starting with those that kill the “usual suspects.” Other medicines may follow once the doctor is sure what’s ailing you, including additional or other antibiotics, antifungal medicines, or antiviral medications.

In addition, your doctor may drain pus from the joint, splint the joint, if necessary, and arrange for you to get physical therapy. Certain infections may also require surgery to clean out the joint.

Caused by the gonococci bacterium — the same culprit responsible for gonorrhea — gonococcal arthritis is the most widespread form of infectious arthritis.

Gonococcal arthritis typically strikes hard and fast, and the pain seems to move from one joint to another. Small blisters can appear on the skin in some or many parts of the body, and the tendons may swell and ache.

Both men and women can develop gonococcal arthritis. Men are much more likely to know that something is wrong because of the penile discharge and painful urination experienced with gonorrhea. Thus, they’re more likely to receive treatment for the disease before it progresses to gonococcal arthritis. Women, who don’t have such obvious symptoms, are less likely to receive early treatment for gonorrhea and more likely to develop gonococcal arthritis, and to suffer from pain in the abdomen and fever related to the disease.

The typical patient with is a young, sexually active person with the signs and symptoms of venereal disease, so the doctor can often zero in on a possible diagnosis of gonococcal arthritis during the medical history and physical examination. The doctor will then check for skin blisters and wait for lab reports on samples of various body fluids before making a definitive diagnosis.

Treatment with standard antibiotics used to be successful, although in recent years certain strains of gonorrhea have become resistant to many drugs. Today, gonococcal arthritis is treated with an injection or infusion of ceftriaxone, a broad spectrum antibiotic that will stop the infection, possibly together with another antimicrobial agent. These medications should knock out the infection but they won’t be able to repair any permanent damage caused by the disease.

Psoriatic arthritis (PsA) adds insult to the injury of psoriasis because it strikes those who are already suffering from this inflammatory disease of the skin. According to the National Psoriasis Foundation, about 30 percent of psoriasis sufferers go on to develop psoriatic arthritis.

In PsA, the joints of the fingers and toes become inflamed, swollen, stiff and, in more severe cases, deformed. There can be pitting of the nails or separation from the nail bed, as well as eye pain and redness. Psoriatic arthritis can also affect the spine, shoulders, or hips.

A specific test for PsA doesn’t exist, so the diagnosis is based on patient history and a physical exam. Typical signs of PsA (besides joint pain) include skin psoriasis, a family history of psoriasis, nail psoriasis, swelling of the fingers or toes (dactylitis), and inflammation of the areas where tendons insert on bone (enthesitis). Psoriatic arthritis is also particularly likely to occur in the joints at the end of the fingers near the fingernails.

Treatment is important, because psoriatic arthritis can cause severe damage to the joints. Unfortunately, it has no cure, but just like RA there are many medicines that have revolutionized its treatment. Standard treatment for PsA includes DMARDs such as methotrexate or biologics such as Humira to slow the progression of the disease and protect the joints from permanent damage.

Though many of the treatments for PsA and RA overlap, they are very different diseases. During the past few years, the FDA has approved several new drugs to treat psoriatic arthritis that don’t work for RA, like secukinumab (Cosentyx) and guselkumab (Tremfya). Chapter 8tells you more about these medications.

Ankylosing spondylitis (AS) attacks and inflames the cartilage, ligaments, and tendons of the spine. The back becomes stiff and sore and as the disease progresses, its ligaments and tendons can become more like bone tissue, forming bony bridges between the vertebrae and locking them into place. In more severe cases, AS can turn the spine into an unbending rod, although the disease usually doesn’t advance to that point. Figure 4-2 shows the difference between a normal spine and one with AS.