Inflammatory arthritis: A comprehensive review

Inflammatory arthritis is a multifaceted category of autoimmune diseases characterised by inflammation of the joints.

Here, Mr Matthew Burwell, renowned consultant orthopaedic surgeon, delves into the intricate landscape of inflammatory arthritis, discussing its symptoms, diagnostic approaches, and therapeutic interventions.

What is inflammatory arthritis?

Inflammatory arthritis refers to a group of autoimmune diseases that primarily affect the joints and connective tissues. Inflammatory arthritis occurs when the body’s immune system, which typically fights against infections, mistakenly attacks the body’s own tissues, leading to inflammation and damage of the joints.

The most common forms of inflammatory arthritis include:

• Rheumatoid arthritis: Rheumatoid arthritis causes inflammation in the lining of the joints, leading to painful swelling and joint deformity.
• Psoriatic arthritis: Associated with psoriasis, psoriatic arthritis causes joint pain and swelling, along with skin lesions.
• Ankylosing spondylitis: Ankylosing spondylitis primarily affects the spine and the sacroiliac joints, leading to chronic back pain and stiffness.

What are the main symptoms indicative of inflammatory arthritis?

Inflammatory arthritis manifests through a range of symptoms that can vary depending on the specific type and severity of each condition.

The common symptoms of inflammatory arthritis include:

• joints that are swollen, tender, and warm to the touch
• persistent or episodic joint pain that worsens with inactivity and improves with movement
• joint stiffness which causes difficulty in moving the affected joints
• the skin over the affected joints is red and feels warm

Additionally, other symptoms include:

• fatigue, persistent tiredness, and lack of energy
• low-grade fevers that often accompany flare-ups of joint inflammation
• unintentional weight loss

How is inflammatory arthritis assessed and diagnosed?

Diagnosing inflammatory arthritis involves a combination of clinical evaluation, laboratory tests, and imaging studies. Here’s a breakdown of the diagnostic process:

Clinical evaluation

• Medical history: The specialist will inquire about symptoms, their onset, duration, and pattern. A family history of arthritis may also be relevant.
• Physical examination: The specialist will examine the joints for signs of inflammation, such as swelling, redness, and warmth. In addition, the specialist will also assess range of motion, deformities, and specific signs characteristic of certain types of inflammatory arthritis.

Laboratory tests

• Blood tests

a) Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests: These are markers of inflammation, and thus elevated levels suggest an inflammatory process.

b) Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibody tests: These are specific markers often used in diagnosing rheumatoid arthritis. Anti-CCP is particularly specific for rheumatoid arthritis.

• Synovial fluid analysis: A sample of fluid from the affected joint is analysed to look for inflammation, crystals (which could indicate gout or pseudogout), and exclude infection.

Imaging studies

• X-rays: X-rays can show joint damage, erosions, or characteristic changes associated with specific types of arthritis (for example, joint space narrowing in rheumatoid arthritis).
• Ultrasound: Ultrasound is useful for detecting early joint inflammation, synovitis, and effusions, which might not be visible on X-rays.
• MRI scan: An MRI scan provides detailed images of joint and soft tissue structures, which is useful for identifying early signs of inflammation and damage not apparent on X-rays or ultrasound.

What are the available surgical and non-surgical treatment options for inflammatory arthritis?

Treatment options for inflammatory arthritis aim to relieve symptoms, reduce inflammation, prevent joint damage, and improve overall function and quality of life.

Conservative treatment options are often the first line of treatment and can be effective in many cases. These treatments include:

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen and naproxen, available over-the-counter, are effective in alleviating both pain and inflammation.
• Corticosteroids: Oral or injectable corticosteroids can provide rapid relief from inflammation during flare-ups.
• Janus kinase (JAK) inhibitors: JAK inhibitors target specific pathways involved in inflammation.

Physiotherapy

• Physiotherapy: A physiotherapist can design an exercise program to improve joint flexibility, strength, and range of motion. The specialist may also provide manual therapy techniques to reduce pain and stiffness.

Assistive devices

• Braces and splints: These can provide support to unstable joints, as well as reduce pain and improve function.
• Orthotic devices: Shoe inserts or custom-made orthotics can help with joint alignment and reduce pain during weight-bearing activities.

Heat and cold therapy

• Heat therapy: Heat therapy involves applying heat packs or taking warm baths/showers to help relax muscles, improve circulation, and reduce joint stiffness.
• Cold therapy: Cold therapy involves applying cold packs or ice packs to help reduce inflammation and numb pain.

For some patients with inflammatory arthritis, conservative treatments may not provide sufficient relief, or joint damage may have progressed to a point where surgical intervention is necessary. Surgical options include:

Surgery

• Synovectomy: Synovectomy involves the surgical removal of the inflamed synovial lining of the joint.
• Joint replacement surgery (arthroplasty): Joint replacement surgery involves the removal of the damaged joint and the subsequent replacement with a prosthetic implant. For example, total hip replacement.
• Arthrodesis (joint fusion): Arthrodesis involves the surgical fusion of the joint, eliminating movement and reducing pain.
• Osteotomy: Osteotomy involves the surgical cutting and realignment of bone to redistribute weight and reduce stress on damaged areas of the joint.

How important is early diagnosis and treatment?

Early diagnosis and treatment are critical for mitigating the impact of inflammatory arthritis and ensuring patient wellbeing. Swift intervention helps to control inflammation, reducing symptoms like pain and stiffness.

In addition, by addressing the disease in its early stages, specialists can also delay its progression, enabling patients to maintain independence. Furthermore, prompt diagnosis and treatment reduce the risk of complications associated with inflammatory arthritis, such as disability and systemic manifestations.

Ultimately, personalised management approaches can be tailored to individual patients when the condition is identified early, optimising treatment strategies and improving patient satisfaction with their care.

If you would like to schedule an appointment with Mr Matthew Burwell, head on over to his Top Doctors profile today.