Public lecture (2013): Arthritis - a joint approach

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How to Determine the Cause of Joint Redness

Three Methods:

Joint redness can indicate a variety of conditions, but there are steps you can take to determine the cause of your symptoms. If you can rule out a recent injury, your symptoms could be due to an underlying condition, such as a form of arthritis or an autoimmune disorder. While there are some obvious differences between the symptoms of various joint conditions, you should consult your doctor and a rheumatologist to make an accurate diagnosis.


Identifying Acute Causes

  1. Determine whether or not the injury is acute.If you have experienced a joint injury, you may experience swelling and redness in the area. Treat a local injury with rest, ice, elevation, and compression. If you observe redness at a recently injured joint, you can likely easily manage the issue at home. Treat redness, swelling, and pain associated with minor injuries using the RICE method: rest the joint, ice the area, apply compression by wrapping it, and keep the affected area elevated above heart level.
    • See a doctor if you experience severe pain, can’t move the joint at all, or can’t bear any weight on an ankle or knee joint.
    • A fracture may also cause swelling and redness around local joints.
  2. See a doctor immediately if you take a blood thinner.Joint redness after a more serious local injury, such as a fracture or torn ligament, can indicate osteoarthritis, or bleeding in the joint spaces. Other symptoms include swelling, warmth, stiffness, and bruising. You should see a doctor if you experience redness accompanied by severe swelling, especially if you take a blood thinner.
  3. Consider any underlying conditions such as osteoarthritis.Redness affecting one or more joints can be associated with a number of underlying conditions, such as osteoarthritis, diabetes, or a systemic inflammatory disease.If you can rule out an acute injury, consult a medical professional and discuss your preexisting conditions.
    • Osteoarthritis incidence increases with age and can present in those individuals who are active but have experienced injury in the past. It also can develop from normal wear and tear as person ages. In osteoarthritis, pain is worse with activity and improves with rest. Osteoarthritis can be managed long-term but occasional joint flare-ups are common.
    • They can also offer a variety of tests to accurately diagnose the cause of joint redness and refer you to a specialist.
  4. Identify a possible autoimmune disease like rheumatoid arthritis.Autoimmune diseases can also cause joint redness. For example, one in five psoriasis patients experience psoriatic arthritis, which results when the immune system attacks joint tissue. Pain usually accompanies redness and swelling, and one or multiple joints can be affected.
    • Other autoimmune disorders include lupus and rheumatoid arthritis (RA), which can cause symptoms in one or multiple joints.
    • Gout is also common among those with RA, and can cause further swelling in the joints.
  5. Determine if joint redness is due to infection.Viral and bacterial infections can cause septic arthritis, which requires prompt medical treatment. Sudden, severe pain and fever typically accompany redness and swelling. Usually, only one joint is affected.

Distinguishing Types of Arthritis

  1. Determine how many joints are affected.Identifying where you observe redness can help you determine the most likely cause. Some forms of arthritis more commonly affect multiple joints, while others often start in one joint.
    • For example, while it can affect any joint, gout usually develops first in the big toe. Redness, swelling, and sudden, severe pain are symptoms of this form of arthritis, which is caused by the buildup of uric acid crystals.
    • Symmetrical redness, with or without pain, swelling, or stiffness, is most often seen in RA. Symmetrical means that symptoms affect both sides of the body, like experiencing redness and pain in both wrists.
  2. Consider your age and how you use the affected joint or joints.Osteoarthritis (OA) is usually due to wear or tear over time, injury, or both. It most commonly affects the lower back, hips, knees, and feet, and usually involves joint stiffness.
    • If you experience redness and stiffness in a joint you’ve recently injured or have used a lot over time, you might be experiencing OA. Symptoms are usually intermittent, or on and off, and occur gradually or after using the joint.
    • Other forms of arthritis are not directly related to joint use or injury and can occur spontaneously at any age.
  3. Determine how suddenly the symptoms appeared.Symptoms of different joint conditions develop at various rates. Sudden redness and pain that’s so severe the joint cannot be moved are more often associated with gout or infection-related septic arthritis.
    • Redness, warmth, or stiffness in the morning that lasts at least 30 minutes but goes away with activity may indicate RA.
    • Redness and stiffness that occur after using the joint or in the morning for less than 30 minutes and gets worse with activity are usually associated with OA.
  4. See a doctor promptly if you have a fever or chills.Redness and pain in one joint accompanied by fever are symptoms of infection-related septic arthritis. Though less common, chills can often accompany fever. You should visit a doctor promptly if you develop these symptoms, as delay could result in permanent joint damage or allow the infection to spread to other parts of your body.
    • Treatment will depend on the results of blood and joint fluid cultures. Septic arthritis is typically due to bacterial infections, such as staphylococcus, which are treated with antibiotics.  

Consulting Medical Professionals

  1. Keep track of your symptoms.Understanding your medical history and how and when your symptoms occur will help your doctor or rheumatologist make an accurate diagnosis. Note when you first observed joint redness, any other accompanying symptoms, and whether symptoms are constant or intermittent.
    • Note what makes your symptoms better and what makes them worse.
    • You should also report any medications, such as anti-inflammatories, that you take to manage your symptoms. Let your doctor know how effectively any medications relieve your symptoms.
  2. See your primary care doctor.It's best to make an appointment with your doctor if you experience persistent redness with or without pain, stiffness, or other symptoms. While there are ways to distinguish various joint conditions, only medical tests can make an accurate diagnosis.
    • You’ll need to see a doctor promptly if you suspect septic arthritis or if you take a blood thinner.
  3. Get a referral to a specialist.Most primary care doctors don’t have the specialized knowledge and experience required to diagnose arthritic conditions with certainty. Since various joint issues have overlapping symptoms, it’s best to have your primary doctor offer an initial examination and, if appropriate, a culture. They should then refer you to a rheumatologist, especially if the issue isn’t related to an infection or local injury.
  4. Get an x-ray, ultrasound, or MRI.You’ll first report your symptoms to your doctor or specialist, then they’ll perform a physical examination and test the joint’s range of motion. Depending on their findings, they’ll likely order imaging techniques, such as an x-ray, ultrasound, or MRI.
    • Imaging techniques will help distinguish between forms of joint inflammation. For example, an ultrasound can detect gout-related urate crystals in a joint.
  5. Get a joint aspiration and culture.Joint aspiration involves drawing fluid from a joint for examination and culture. It’s useful for distinguishing between cases of gout and septic arthritis, so your doctor or specialist might order the procedure if they suspect either of these conditions.
    • Blood and joint fluid cultures can identify a bacterial or fungal infection that’s caused septic arthritis.
    • Examining joint fluid for urate crystals can diagnose gout.
  6. Discuss how to manage RA or OA.Your diagnosis will determine the best treatment or management options. The best ways to manage many cases of OA and RA are rest, eating a calcium-rich diet, applying heat or cold in 20 minute intervals, and taking over the counter anti-inflammatories.
    • At first, you should try applying both heat and ice packs at different times. See which works better for you, then stick to whichever provides relief.
    • Wrapping the area might also reduce redness and inflammation.
    • Your doctor or specialist might suggest corticosteroids and topical pain relievers. In cases of severe joint damage or deterioration, they might recommend joint replacement.
  7. Treat or manage other causes of joint inflammation.Anti-inflammatories and pain relievers are used to manage gout. Additionally, medications that improve uric acid removal can help prevent gout flare-ups.
    • Antibiotics are used to treat infection-related septic arthritis.
    • In addition to corticosteroids and anti-inflammatories, specialized medications are used to manage psoriatic arthritis.
  8. Contact your insurer to avoid surprise medical costs.Call your insurer before undergoing lab tests or imaging techniques to make sure all procedures are covered. Ask them if your rheumatologist is in-network, or ask them to refer one in your network, in order to ensure specialist care is covered.
    • Ask your insurer, “My doctor has recommended a joint aspiration and x-ray.

Video: Rheumatoid Arthritis | Nucleus Health

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