RA, SLE, vasculitis, crystal arthropathies, spondyloarthropathies, and connective tissue diseases with immunological investigations.
Chronic inflammatory spondyloarthropathy predominantly affecting the sacroiliac joints and spine, causing progressive spinal fusion. Strongly associated with HLA-B27 (>90% of cases). Now classified under the umbrella term axial spondyloarthritis (axSpA), which includes non-radiographic axSpA.
Autoimmune prothrombotic disorder characterised by recurrent arterial and venous thrombosis and/or obstetric morbidity in the presence of persistent antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I). Can be primary or secondary (associated with SLE in 30-40%).
Compression neuropathy of the median nerve at the wrist, causing pain, paraesthesiae, and weakness in the median nerve distribution. Most common peripheral nerve entrapment. Treated with splinting, injection, or surgical decompression.
Pain persisting beyond the expected healing time (typically >3 months) that becomes a condition in its own right rather than a symptom of tissue damage. Classified by ICD-11 as chronic primary pain and chronic secondary pain. Management is multimodal, combining physical, psychological, and pharmacological approaches.
Group of conditions caused by deposition of crystals in joints, primarily gout (monosodium urate) and pseudogout (calcium pyrophosphate). Definitive diagnosis requires joint aspiration and polarised light microscopy.
Inflammatory arthritis associated with inflammatory bowel disease (Crohn's disease and ulcerative colitis). Classified as a spondyloarthropathy. Peripheral arthritis may parallel bowel disease activity, while axial disease typically runs an independent course.
ANCA-associated small-vessel vasculitis (formerly Churg-Strauss syndrome) characterised by asthma, eosinophilia, and granulomatous vasculitis. ANCA (p-ANCA/MPO) positive in only 40% of cases. Distinguished from other AAV by prominent eosinophilia and asthma.
Chronic widespread pain syndrome characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction ('fibro fog') in the absence of an identifiable structural or inflammatory cause. Affects 2-4% of the UK population, predominantly women.
Adhesive capsulitis causing progressive painful restriction of shoulder movement in all planes. Strongly associated with diabetes (~20% of diabetics affected). Self-limiting over 1–3 years.
Large-vessel vasculitis predominantly affecting branches of the external carotid artery (especially the temporal artery) in patients over 50 years. A medical emergency due to the risk of irreversible visual loss from anterior ischaemic optic neuropathy. Requires immediate high-dose glucocorticoids.
Crystal arthropathy caused by deposition of monosodium urate (MSU) crystals in joints and soft tissues due to chronic hyperuricaemia. Presents as acute, intensely painful monoarthritis, classically of the first metatarsophalangeal joint (podagra). Managed acutely with NSAIDs, colchicine, or corticosteroids, and chronically with urate-lowering therapy.
ANCA-associated small-vessel vasculitis (formerly Wegener granulomatosis) characterised by necrotising granulomatous inflammation of the upper and lower respiratory tract and necrotising glomerulonephritis. Strongly associated with c-ANCA/PR3 antibodies.
ANCA-associated small-vessel vasculitis characterised by necrotising vasculitis without granulomata, predominantly affecting the kidneys and lungs. Strongly associated with p-ANCA/MPO antibodies. Distinguished from GPA by the absence of granulomatous inflammation and upper airway involvement.
Overlap autoimmune syndrome with features of SLE, systemic sclerosis, and polymyositis, defined by the presence of high-titre anti-U1 RNP antibodies. Raynaud phenomenon, swollen hands, arthritis, myositis, and ILD are the most common manifestations.
Most common joint disease worldwide, characterised by progressive cartilage loss, subchondral bone remodelling, and osteophyte formation. Affects predominantly weight-bearing joints (knees, hips) and the hands. Clinical diagnosis based on typical features without routine bloods or imaging required.
Bone infection most commonly caused by Staphylococcus aureus, classified as acute haematogenous (children), contiguous spread (adults), or associated with vascular insufficiency (diabetic foot). Requires prolonged antibiotic therapy.
Systemic skeletal disease characterised by reduced bone mineral density and microarchitectural deterioration, leading to increased fracture risk. Diagnosed by DXA T-score ≤-2.5 or fragility fracture.
Focal disorder of accelerated bone remodelling resulting in disorganised, enlarged, and structurally weak bone. Most commonly affects the pelvis, spine, skull, and femur in older adults.
Common cause of heel pain due to degeneration and inflammation of the plantar fascia at its calcaneal insertion. Characterised by 'first-step' pain that improves with walking.
Necrotising vasculitis of medium-sized arteries with characteristic microaneurysm formation. Distinguished from ANCA-associated vasculitis by the absence of glomerulonephritis and ANCA negativity. Historically associated with hepatitis B, though idiopathic cases are now more common.
Common inflammatory condition in older adults characterised by bilateral shoulder and hip girdle pain and stiffness with raised inflammatory markers. Responds dramatically to low-dose corticosteroids. Closely associated with giant cell arteritis (15-20% have coexistent GCA).
Idiopathic inflammatory myopathy characterised by symmetric proximal muscle weakness without the skin manifestations of dermatomyositis. CD8+ T-cell-mediated direct myofibre injury is the pathological hallmark. Now considered rare as many previously classified cases are reclassified as immune-mediated necrotising myopathy or inclusion body myositis.
Crystal arthropathy caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition in joint cartilage and synovial fluid. Presents as acute monoarthritis mimicking gout, predominantly affecting the knee and wrist. Commonly affects elderly patients and is associated with osteoarthritis, hyperparathyroidism, and haemochromatosis.
Inflammatory arthropathy associated with psoriasis, affecting up to 30% of psoriasis patients. Characterised by diverse patterns including peripheral arthritis, axial disease, dactylitis, and enthesitis. Distinguished from RA by DIP involvement, dactylitis, nail changes, and typical seronegativity.
Sterile inflammatory arthritis occurring 1-4 weeks after a genitourinary or gastrointestinal infection. Part of the spondyloarthritis family, strongly associated with HLA-B27. Previously known as Reiter syndrome (classic triad of arthritis, urethritis, and conjunctivitis).
Chronic, systemic autoimmune inflammatory arthropathy characterised by symmetrical, destructive polyarthritis predominantly affecting the small joints of the hands and feet. It is the most common inflammatory arthritis, affecting approximately 1% of the UK population. Early diagnosis and aggressive DMARD therapy within 3 months of symptom onset significantly improves outcomes.
Acute bacterial infection of a joint constituting an orthopaedic emergency. Most commonly caused by Staphylococcus aureus. Requires urgent joint aspiration and IV antibiotics to prevent irreversible cartilage destruction.
Chronic autoimmune condition characterised by lymphocytic infiltration and destruction of exocrine glands, particularly salivary and lacrimal glands, causing dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). Can be primary or secondary (associated with RA, SLE, or other autoimmune conditions). Carries a 5-10% lifetime risk of B-cell lymphoma.
Narrowing of the spinal canal causing compression of the spinal cord or nerve roots, most commonly in the lumbar spine. Characterised by neurogenic claudication relieved by flexion/sitting.
Chronic, multisystem autoimmune disease characterised by autoantibody production (particularly anti-nuclear and anti-dsDNA antibodies) and immune complex deposition, causing inflammation in skin, joints, kidneys, brain, blood, and serosal surfaces. Predominantly affects women of childbearing age with increased prevalence in Afro-Caribbean and South Asian populations.
Chronic autoimmune connective tissue disease characterised by fibrosis of the skin and internal organs, vasculopathy, and immune activation. Classified as limited cutaneous (lcSSc, formerly CREST syndrome) or diffuse cutaneous (dcSSc). Anti-centromere antibodies associate with limited disease; anti-Scl-70 (anti-topoisomerase I) with diffuse disease.
Large-vessel vasculitis predominantly affecting the aorta and its major branches, occurring primarily in young women under 40 years. Causes arterial stenosis, occlusion, and aneurysm formation leading to limb claudication, absent pulses, and renovascular hypertension.
Chronic tendon disorder characterised by pain, swelling, and impaired function, most commonly affecting the Achilles, patellar, and rotator cuff tendons. Pathology involves failed healing rather than inflammation.