Category Archives: Rheumatology and bone disease

Neck pain

Pain in the neck may be caused by RA, ankylosing spondylitis, soft-tissue rheumatism or fibromyalgia. In addition, disc disease, both acute and chronic, the latter in association with OA, may occur in the neck as well as in the lumbar spine. The three lowest cervical discs are most often affected and there is pain and stiffness of the neck with or without root pain radiating to the arm. Chronic cervical disc

Psychogenic back pain

Diagnostic points include: • Young adult females predominantly affected • Continuous unvarying pain, often described in vivid terms; no relief from rest, which usually helps even the most severe organic conditions • Long history of treatment failures, including with analgesics • Associated symptoms, e.g. headaches; history of fruitless investigation of symptoms from other systems • Sometimes depression

Mechanical problems

There are two mechanical problems in the spine that are of particular importance because they are amenable to surgical treatment: spondylolisthesis and spinal stenosis. Spondylolisthesis This condition arises because of a defect in the pars interarticularis of the vertebra, which may be either congenital or acquired. It gives rise to a slipping forward of one vertebra on another, most commonly at L4/L5. The a

Inflammatory back pain

Ankylosing spondylitis is described  and is the most important cause of inflammatory back pain. Disc disease The term ‘disc disease’ is used to describe two common clinical problems which are due to degenerative change in the intervertebral disc, a process in cartilage which is not unlike OA. There is an acute syndrome in which disc prolapse causes conditions that are known to the public as eithe

Back pain

Back pain is extremely common. It can be mild and transient, or chronic and disabling. In many cases, the exact cause is not established. In Britain 375000 people lose some time from work each year because of back pain, an annual loss of 11.5 million working days, and back pain accounts for 6% of general-practice consultations. Back pain is not usually serious and mostly resolves; in one survey 44% of cases

Less-common arthropathies

Amyloidosis Primary amyloidosis causes a polyarthritis that resembles RA in distribution and it is also often associated with carpal tunnel syndrome and subcutaneous nodules. Ankylosing vertebral hyperostosis (Forrestier’s disease) This is a condition of elderly people in which exuberant osteophytes are found in the spine, particularly the dorsal region. It is often asymptomatic, but it may be confused

Arthritis associated with other diseases

Gastrointestinal and liver disease Enteropathic synovitis This is associated with HLA B27 and IS described. Autoimmune chronic active hepatitis  This may be accompanied by an arthralgia that is like that seen in SLE. Joint pain occurs in a bilateral, symmetrical distribution, with the small joints of the hands being prominently affected. Joints usually look normal but sometimes there is a slight soft-tissue s

Crystal deposition diseases

Three types of crystal are deposited in joints; each is associated with a characteristic clinical syndrome: 1 Monosodium urate deposition is associated with acute gout, typically affecting the big toe. 2 Calcium pyrophosphate deposition causes many different syndromes including pseudo gout, which most often affects the knee. 3 Hydroxyapatite deposition causes acute calcific periarthritis and most often affects

Arthritis in children

Joint pain is a common problem in childhood but arthritis is fortunately rare. Benign limb pain in childhood is sometimes called ‘growing pain’ and, though meaningless, this is probably a convenient term that parents readily accept. JUVENILE CHRONIC ARTHRITIS Juvenile chronic arthritis is a general term used to cover a group of diseases in which an exact diagnosis is not always possible. There are

Differential diagnosis of arthritis in the elderly

Common conditions are summarized . OA is common from the age of 50 years onwards but is easily distinguished from polymyalgia rheumatica by its less dramatic onset, peripheral distribution and normal ESR; if there is any doubt, a 1 week trial of prednisolone should be given. RA can begin in elderly patients. It is often sudden in onset, with very dramatic joint inflammation (‘explosive’ RA). Unl