Diagnosis and Treatment of Inflammatory Joint Disease

Abstract

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.

Keywords: Ankylosing spondylitis; Gout; Reactive arthritis; Rheumatoid arthritis.

Fig. 1. Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (SpA).

HLA: human leukocyte antigen, MRI: magnetic resonance imaging, NSAIDs: nonsteroidal anti-inflammatory drugs, CRP: Creactive protein. Data from the article of Rudwaleit M et al. (Ann Rheum Dis 2009;68:777-83).

Fig. 2. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis.

Data from the article of Aletaha D et al. (Arthritis Rheum 2010;62:2569-81).

Fig. 3. Definition and remission of rheumatoid arthritis disease presented by the American Society of rheumatoid diseases.

Data from the article of Singh JA et al. (Arthritis Rheumatol 2016;68:1-26).

Fig. 4. European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.

Data from the article of Smolen JS et al. (Ann Rheum Dis 2017;76:960-77).

Fig. 5. The presence of double contour sign in gout.