Diagnose various types of arthritis by physical findings.

Explanation: Key findings are as follows:

Psoriasis-Telescoping joints, cutaneous psoriatic plaques, asymmetric but may sometimes mimic RA, X-ray with Pencil & cup deformity-

RA-Symmetrical poly-arthritis,Swan neck, ulnar deviation, Boutennaire's,Sub-cutaneous nodes(this indicates Rheumatoid factor positivity)

OA-Heberden's nodes(DIP),Bouchards nodes (PIP)Crepitus in joint

Gout-Podagra(1st MTP Joint flare) is presenting feature in >50%.Nocturnal flare up, cannot stand any touching on the joint area - not even blowing air on it or placing a sheet.  MONOARTHRITIS therefore have to rule out septic arthritis.Patients can have chills/fever. If patient is not middle aged- look for cause. Do not check uric acid level during the acute attack as these drop. Diagnosis with synovial fluid showing strongly negatively birefringent needle crystals. Treat with INDOMETHACIN/other NSAID. Avoid diuretics and aspirin(low dose) If GI bleed risk- use Colchicine or inject steroids into affected joint. DO NOT USE ALLOPURINOL IN THE ACUTE SETTING. IN PATIENTS ON AZATHIOPRINE CUT DOSE OF AZATHIOPRINE TO 25%. For prevention- Lifestyle modification, Colchicine(low dose) and allopurinol(if 24 hr urine has > 800 mg uric acid) or uricosuric agent like Sulfinpyrazone/Probenecid (if pt is undersecretor <800 mg/24 hr)are helpful.

Septic arthritis- Mono-arthritis, erythematous base of a vesico-pustular lesion.Mobility of joint is SEVERELY RESTRICTED

Scleroderma-Acro-osteolysis,diffuse thickening of skin, telangiectasia,Raynaud's phenomenon, Pulmonary fibrosis, Renal artery spasm -> hypertension (DOC=ACE Inhibitor).