REHB1001 Chap.9 Inflammatory and Degenerative Arthritis
Inflammatory and Degenerative Arthritis
Osteoarthritis and rheumatoid arthritis open the clinical pattern notebook in Week 4, and ankylosing spondylitis follows in Week 8. This chapter maps which joints each lecture lists, contrasts the subjective patterns, morning stiffness, blood markers and examination findings, and works a counter-example in which a young woman's inflammatory arthritis is mislabelled as early osteoarthritis.
It closes with management, the C1 to C2 precaution in rheumatoid arthritis, uveitis in spondylitis, and the physiotherapist's role in the team. Practice items include a viva-style question on the physiotherapist's place in the team, following the shape of the Week 8 sample viva.
What this chapter covers
- 01
Osteoarthritis as whole-joint disease
- 02
Rheumatoid arthritis as systemic inflammation
- 03
Ankylosing spondylitis and HLA-B27
- 04
Which joints each condition affects
- 05
Activity response and morning stiffness
- 06
Precautions: C1 to C2 subluxation and uveitis
- 07
Exercise, medication and the team
Worked example · free
Telling the three patterns apart from the joint map
- +1(a) Rheumatoid arthritis: symmetrical small joints and wrists, typical onset in the fourth or fifth decade in women.
- +1(b) Ankylosing spondylitis: inflammatory back pain in a young adult that improves with movement and is not relieved by rest.
- +1(c) Osteoarthritis: knee pain aggravated by walking, rising in prevalence after 65.
Key terms
- Pannus
- An abnormal layer of synovial tissue that invades and erodes the joint in rheumatoid arthritis.
- Enthesitis
- Inflammation where tendons, ligaments or capsules attach to bone.
- Seronegative
- Typically negative for rheumatoid factor and antinuclear antibody.
- Anterior uveitis
- Eye inflammation causing sudden pain, redness, light sensitivity or blurred vision.
- Osteophyte
- A bony outgrowth at the joint margin seen in osteoarthritis.
- Disease-modifying drugs
- Medicines that control the inflammatory process in conditions such as rheumatoid arthritis.
Inflammatory and Degenerative Arthritis FAQ
How long is morning stiffness in each condition?
All three lectures describe stiffness of more than 30 minutes, so duration alone does not separate them. Rheumatoid arthritis stiffness often lasts hours. Combine stiffness with distribution, age, activity response and systemic features before deciding which pattern fits, and say which combination led you there.
Does a positive HLA-B27 test mean someone has ankylosing spondylitis?
No. The lecture reports that up to 90% of people with ankylosing spondylitis are HLA-B27 positive, but only about 1 to 5% of positive people develop it. The gene supports the picture; diagnosis rests on clinical features plus imaging. The sample viva tests exactly this point.
What is the most effective treatment for knee or hip osteoarthritis?
The lecture states that physical activity or exercise with self-management is the safest and most effective treatment: a healthy weight together with strengthening and aerobic exercise. Manual therapy, gait aids, home modifications and analgesics support it, with joint replacement as the surgical option.
What are the risk factors for osteoarthritis?
The lecture lists obesity, physical inactivity, past joint injury such as an ACL rupture, muscle weakness, osteoarthritis in the opposite joint, other factors yet to be identified, and social determinants of health. Several are modifiable, which is one reason exercise and weight management sit at the centre of treatment.
Why does rheumatoid arthritis need early diagnosis?
Because untreated disease destroys the joint and can shorten life. The lecture describes synovial overgrowth forming a pannus that erodes cartilage and bone, notes that X-rays may look normal early, and stresses that early diagnosis and treatment are crucial, so suspicious patterns should be referred promptly.
Where does the pain in osteoarthritis come from?
Not from the cartilage, which the lecture notes has no blood supply or nerves. Pain more likely arises from the capsule, synovium, subchondral bone, ligaments and surrounding muscles. This helps explain why imaging changes and symptoms often disagree, and why exercise can reduce pain without reversing the joint changes.
Exam move
Build a three-column clinical pattern table for these conditions using the template headings, and test yourself by covering one column. Draw the joint map from memory. Practise a two-minute spoken answer on the physiotherapist's role in ankylosing spondylitis, and rehearse the two red flags until you can name them without prompting.
Rehearse the lecture's take-home points for rheumatoid arthritis: a systemic illness, many joints, comorbidities, medication as the main treatment, and osteoarthritis as the differential.
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