Asymmetric arthritis affects the joints on just one side of the body. There are many other types and characteristics of arthritis, and treatment may vary slightly depending on the type of arthritis a person has.
In this article, learn about the difference between symmetric and asymmetric arthritis. We also cover diagnosis and treatment. A person with symmetric arthritis will experience symptoms in mirrored joints on both sides of the body. For example, a person with symmetrical arthritis of the knee will have symptoms in both knees at the same time. A person with asymmetric arthritis will only experience symptoms in joints on one side of the body, for example, in a knee and a wrist.
Inflammatory arthritis generally occurs because of an underlying issue, such as an autoimmune response. Noninflammatory arthritis usually has a physical cause, such as an injury or wear and tear on the joints. Rheumatoid arthritis RA is an inflammatory, symmetrical form of arthritis. Symmetry is the key determinant in diagnosing this autoimmune disease. However, a person may not have symptoms on both sides at the beginning of the disease.
It will become symmetrical as the disease progresses. Noninflammatory forms of arthritis caused by wear and tear, such as osteoarthritis, typically produce asymmetrical symptoms. Symptoms frequently occur in the spine and the weight bearing joints, such as the knee or hip, but can occur in any joint.
Psoriatic arthritis PsA is an inflammatory type of arthritis. However, it can cause both symmetrical and asymmetrical symptoms, which distinguishes it from other forms of arthritis. Typically, however, people who have PsA experience asymmetrical symptoms.
The syndrome ordinarily emerges after years of seropositive, persistently active rheumatoid arthritis; however, vasculitis may occur when joints are inactive. Addional information on vasculitis can be found on our Vasculitis Center website. The most common neurologic manifestation of rheumatoid arthritis is a mild, primarily sensory peripheral neuropathy, usually more marked in the lower extremities.
Entrapment neuropathies e. Cervical myelopathy secondary to atlantoaxial subluxation is an uncommon but particularly worrisome complication potentially causing permanent, even fatal neurologic damage. This is characterized by splenomegaly, and leukopenia — predominantly granulocytopenia. Recurrent bacterial infections and chronic refractory leg ulcers are the major complications.
The course of rheumatoid arthritis cannot be predicted in a given patient. Several patterns of activity have been described:. Recent studies have demonstrated an increased mortality in rheumatoid patients.
Median life expectancy was shortened an average of 7 years for men and 3 years for women compared to control populations. In more than patients with rheumatoid arthritis from four centers, the mortality rate was two times greater than in the control population. Patients at higher risk for shortened survival are those with systemic extra-articular involvement, low functional capacity, low socioeconomic status, low education, and prednisone use. With the advent of therapies to better control inflammation and treatment strategies geared to low disease activity and remission, it is hoped that the statistics concerning disability and mortality will improve.
No laboratory test will definitively confirm a diagnosis of rheumatoid arthritis. However, the information from the following tests contributes to diagnosis and management.
Similarly, the platelet count is usually normal but thrombocytosis occurs in response to inflammation. Chemistry tests are usually normal in rheumatoid arthritis with the exception of a slight decrease in albumin and increase in total protein reflecting the chronic inflammatory process.
Renal and liver function are important to check before beginning treatment and are followed over time with many medications. A positive Anti-CCP is a more specific marker for RA and is found in similar proportions of patients over the course of disease. High levels of Anti-CCP also appear to be linked to a greater severity of the disease. Measures of inflammation are often, but not always increased in RA. The erythrocyte sedimentation rate ESR is usually elevated in patients with RA and in some patients is a helpful adjunct in following the activity of the disease.
The C-reactive protein CRP is another measure of inflammation that is frequently elevated, and improves with control of disease activity.
Testing for hepatitis B and C and testing for tuberculosis are commonly done as part of an initial evaluation. You can also benefit from chiropractic care , which is now available at Integrated Pain Consultants for your convenience. Particularly for those who have arthritis or any type of pain in the spin, a chiropractor can help pinpoint issues and restore alignment so the body can help to heal itself.
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If you need immediate assistance, please call Symmetric vs. The underlying assumption behind the current analysis is that radiographic damage is a more robust measure of symmetry. The relationship between synovitis and erosions in individual joints has been reported as strong by a few investigators [ 12 — 14 ], but Kirwan [ 15 ] reported a low correlation between clinical synovitis and erosive progression in individual joints.
However, in that study the seropositive patients had more symmetrical pairs of clinically involved joints, though not erosions, compared with the seronegative subjects. A further study of 17 RA patients who were seronegative, matched with seropositive controls, showed similar global symmetry, although seropositive patients tended to have more and larger erosions [ 16 ].
However, this was a comparison of global symmetry and did not assess individual joints or joint groups or the feet. A larger study of patients with RA [ 17 ], using an analysis similar to that used in the present study, illustrated that RF status did not influence symmetry.
There were more patients with erosions in the seropositive group, and this might have influenced their estimates. Finally, Thould and Simon [ 18 ] reported that the more severe the radiological involvement in the feet, the less likely was asymmetry in their cohort of patients with definite RA according to the criteria. There was no comparison of symmetry of the hand joints in that study. Helliwell et al. This was in an analysis of the difference between early and late psoriatic arthritis and rheumatoid arthritis.
Our findings are different from those observed in the literature in that we ignored the ARA criteria for RA in which symmetry would be a foregone conclusion and used an unselected cohort of patients with IP. We deliberately chose to study a group unselected by a diagnostic process influenced by the presence of symmetry.
We have thus demonstrated that erosive joint damage is more frequently symmetrical than expected by chance, and this is the case irrespective of RF production. Finally, a biological explanation for the symmetry of erosions has not been forthcoming, although there are some data to support neurological influence on inflammation.
In one experiment [ 20 ], the electrical stimulation of C fibres in experimental animals produced a symmetrical inflammatory response despite being applied unilaterally. Other reports have shown that the injection of inflammatory crystals in one footpad of rats produces swelling in the other footpad [ 21 ]. This indicates that a mechanism exists whereby afferent nerves from one joint can induce an inflammatory response in the contralateral joint by inducing the release of inflammatory mediators.
In conclusion, patients with inflammatory polyarthritis display symmetry of erosive disease course independently of their RF status. If the contingency table to be fitted contains n cells, then n parameters can be fitted to provide a perfect fit to the data: this is called a saturated model.
If fewer parameters are fitted, the difference between the fitted model and the saturated model can be tested with a likelihood ratio statistic G 2 ; if the difference between the models is not statistically significant, the simpler model is an adequate fit to the data. Thus, up to four parameters may be fitted. The parameterization we used is shown in Table 5. The parameters fitted are all of the above parameters and their interactions with RF status.
However, these models only measure the increased risk of erosion in a joint given erosions in the corresponding joint on the opposite side. This may be due to erosions occurring symmetrically, or it may simply be due to the fact that, given erosion at a particular site, the risk of erosions at all sites is increased.
Strictly, symmetry implies that the elevated risk in the corresponding joint on the contralateral side is greater than the elevated risk in other joints. To test this, more complex models involving more than one joint site are required. However, the number of parameters required increases exponentially with the number of joint sites, and modelling all four sites simultaneously would require a table with cells.
Not only would this be prohibitively complex, but many cells would be empty, making inference problematic. Therefore a model containing only PIP and MCP joints was fitted to test whether the increased risk of erosion, given an erosion at one site, was greater at the contralateral site than elsewhere. Suppose that the probability of developing an erosion on one side is p and that this probability is same on each side. If a sample of n subjects is investigated, the observed and expected numbers of subjects with erosions on each side would be as in Table 6.
We want to fit a model to the observed numbers a , b and c , and calculate the expected value of d from this model. This amounts to calculating p 2 n in terms of a , b and c. Correspondence to: A. Bull Rheum Dis ; 9 : —6. The American Rheumatism Association revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum ; 31 : — The epidemiology of chronic rheumatism.
Oxford: Blackwell, Primer on the rheumatic diseases. Atlanta: Arthritis Foundation, Radiographic progression in rheumatoid arthritis: a long term prospective study of patients. Arthritis Rheum ; 41 : — Baillieres Clin Rheumatol ; 10 : — The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol ; 33 : —9.
Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn ; 18 : — Agresti A. Loglinear models for contingency tables. In: Agresti A, ed. Seronegative and seropositive rheumatoid arthritis: similar diseases.
Br J Rheumatol ; 26 : — Burns TM, Calin A.
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