Arthritis and osteoarthritis: Medical history
Are you wondering how to assess the medical history of patients with osteoarthritis or
arthritis?
In this episode, we’ll be presenting the most important points and how to differentiate
between both conditions.
The risk of developing osteoarthritis increases with age.
This is because damage to the affected joint develops slowly over a long period of time.
However, there’s one exception: Osteoarthritis can also develop at a younger age but as a
result of an underlying condition, for example, joint malalignment or a previous joint infection.
In osteoarthritis, pain usually occurs as a result of excessive joint loading.
Cartilage destruction leads to functional impairment in affected joints.
In addition, pain usually worsens at night, because the joint is exacerbated by activity
with pain worsening over the course of the day.
Rest or joint relief can ease the pain.
Many patients complain that their pain worsens in Winter and that heat helps in reducing
their discomfort.
So, why don’t we summarize all of these main points on osteoarthritis?
Osteoarthritis occurs primarily in older individuals.
Patients usually report increased pain as a result of joint loading, which increases
at night and is relieved by rest or heat.
Now, let’s move on to arthritis.
Most arthritis types are caused by autoimmune diseases.
They can occur in any age group but show a certain age-specific dependency on the basis
of the underlying causative arthritic disease.
In addition, sex can determine the probability of developing a rheumatic disease.
Let’s go into further detail: Rheumatoid arthritis is most commonly diagnosed in young
to middle-aged women, whereas systemic lupus erythematosus often affects young women.
Gout is common in middle-aged men and women of post-menopausal age.
In contrast, spondyloarthropathies usually affect young men.
So, although the arthritides can occur in all age groups, which is in contrast to osteoarthritis,
the development of arthritis focuses on particular life stages or sex, depending on the cause.
Let’s move on to the next point, pain.
Contrary to osteoarthritis, pain at rest is one of the characteristics of arthritis.
Accordingly, patients report increased pain in the morning after sleep or long periods
of rest.
The term morning stiffness is used here and is an important indicator of arthritis.
By definition, morning stiffness is present if pain persists for more than 30 minutes
after waking.
As arthritic pain is greatest at rest, physical activity can help alleviate pain.
It’s not entirely clear why it helps reduce pain, but it helps to differentiate between
osteoarthritis and arthritis.
Both conditions also differ in terms of heat or cold therapies.
Many patients with arthritis report that applying cold to the affected joint helps alleviate
pain.
This is quite likely, as cold temperatures have a pain inhibitory and anti-inflammatory
effect.
So, now let’s finish this section by summarizing some of the characteristics of arthritis.
Age distribution depends on the type of disease.
Arthritis is characterized by pain at rest and in the morning that is alleviated through
physical activity and cold therapy.
Another difference between the two conditions is the time period in which pain develops.
In osteoarthritis, pain develops gradually over years, with patients usually consulting
their physician once they experience substantial pain.
When questioned about the duration of joint pain, the patient admits initially experiencing
mild pain that started several years ago.
Accordingly, osteoarthritis is considered a chronic condition.
In contrast, arthritic pain develops over a short period of time.
It can be subacute, acute, or hyperacute.
Hyperacute describes a very sudden course and is observed, for example, in gout, with
pain developing rapidly over several hours and can be quite severe.
It occurs usually in the evening after consuming alcohol or meat.
Septic arthritis is characterized by an acute course, with pain developing within several
hours to days.
It can be caused by the direct invasion of the joint space by bacteria or viruses.
Alternatively, it can occur after joint aspiration and subsequent bacterial infection.
Septic arthritis is considered a medical emergency.
However, most arthritides develop comparatively slower, usually from weeks to months.
Examples are rheumatoid arthritis, connective tissue diseases, including systemic lupus
erythematosus, and spondyloarthropathies.
In such cases, patients can’t usually specify the exact starting point.
In contrast, patients with gout are sometimes able to pinpoint the exact time of pain onset.
So, time course can also be used to narrow down a particular condition.
A very decisive aspect is, of course, the joint affected.
In part 3 of our Chalk Talk series on arthritis and osteoarthritis, we’ll provide an overview
of the affected joints.
We’ll also explain some terms, such as spondyloarthropathy, in further detail.