Arthritis More Arthritis Types & Related Conditions Overview of Inflammatory Arthritis By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by Scott Zashin, MD on October 11, 2020 linkedin Scott J. Zashin, MD, is board-certified in internal medicine and rheumatology. He was a volunteer clinical professor of internal medicine at the University of Texas Southwestern Medical School Dallas. Learn about our Medical Review Board Scott Zashin, MD on October 11, 2020 Print Inflammatory types of arthritis may involve multiple joints simultaneously. Often, an overactive or malfunctioning immune system is the cause of inflammation. The primary symptoms of inflammatory types of arthritis are pain and stiffness in the morning or after periods of rest or inactivity. In patients with inflammatory arthritis, the period of morning stiffness typically exceeds 60 minutes. PIKSEL / Getty Images Swelling, redness, and warmth also are common in or around the affected joints. Inflammatory arthritis not only affects the joints — other body parts can be affected, including the skin or internal organs. Inflammatory arthritis can affect people of all ages, but often strike people in the prime of life. Swelling does not always occur with inflammatory arthritis. While that may seem uncharacteristic, actually inflammatory arthritis patients may have pain without swelling, swelling without pain, or physical limitations without either pain or swelling. Types of Inflammatory Arthritis The three most common types of chronic inflammatory arthritis are rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. But, there are others as well. In patients who exhibit musculoskeletal symptoms, inflammatory conditions that do not have joint involvement may include bursitis, tendinitis, or polymyalgia rheumatica. Patients who have one to three joints involved may have an acute inflammatory condition such as infectious arthritis, gout, pseudogout, Reactive arthritis, or Chlamydial arthritis — or a chronic inflammatory condition such as psoriatic arthritis, spondyloarthropathy, pauciarticular juvenile arthritis, or infectious arthritis that is slow to heal. Patients who have four or more joints involved may have acute inflammatory conditions such as viral arthritis, drug-induced arthritis, early connective tissue disease, rheumatic fever, palindromic rheumatism, or remitting seronegative symmetrical synovitis with pitting edema (RS3PE) — or chronic inflammatory conditions such as rheumatoid arthritis, undifferentiated polyarthritis, inflammatory osteoarthritis, mixed connective tissue disease, lupus, scleroderma, polyarticular juvenile arthritis, or adult Still's disease. How Is Inflammatory Arthritis Diagnosed? Elevation in acute phase reactants serves as indicators of inflammation. While the two most often utilized, CRP and sedimentation rate, are indicative of inflammation, they do not differentiate between rheumatoid arthritis and other inflammatory types of arthritis. Also, not all patients with inflammatory arthritis will have elevated CRP or sedimentation rate initially. Some patients may instead have elevated levels of ferritin, haptoglobin, ceruloplasmin, or complement. Other markers indicative of an inflammatory type of arthritis are anemia of chronic disease, elevated platelets, and elevated white cell count. There are serologic tests to help pin down the diagnosis. Rheumatoid factor is commonly ordered when rheumatoid arthritis is suspected. But, not everyone with rheumatoid arthritis is positive for rheumatoid factor (seropositive). About 20 percent of patients diagnosed with rheumatoid arthritis are negative for rheumatoid factor (seronegative). In early arthritis (symptoms for less than a year) rheumatoid factor sensitivity is about 17-59 percent, according to Kelley's Textbook of Rheumatology. The specificity is also not good in early rheumatoid arthritis, since other conditions may be associated with a positive rheumatoid factor (e.g., lupus, Sjogren's syndrome). Even 4-5 percent of the general population is positive for rheumatoid factor. Other serologic tests, such as anti-CCP and ANA can provide more diagnostic information, in addition to CRP, sedimentation rate, and rheumatoid factor. Testing for certain genetic markers can be helpful. For example, HLA-B27 positivity is strongly associated with ankylosing spondylitis. Also, synovial fluid analysis can provide information regarding inflammation — synovial fluid from an inflamed joint is typically yellow and turbulent, with white cell counts above 10,000 cells/mm, with the greatest percentage being neutrophils. Imaging is also utilized as part of the diagnostic process for inflammatory arthritis. X-ray evidence of inflammatory arthritis may include soft tissue swelling, chondrocalcinosis, joint effusion, osteopenia near the joint, symmetric loss of cartilage, joint space narrowing, and bony erosions. Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Inflammatory arthritis. Hospital for Special Surgery [internet]. Illinois Department of Public Health. Rheumatoid. Healthbeat [internet]. Häuser W, Perrot S, Sommer C, Shir Y, Fitzcharles MA. Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep. 2017;2(3):e598. doi:10.1097/PR9.0000000000000598 Jain S, Gautam V, Naseem S. Acute-phase proteins: As diagnostic tool. J Pharm Bioallied Sci. 2011;3(1):118–127. doi:10.4103/0975-7406.76489 Neto R, Salles N, Carvalho J. The use of inflammatory laboratory tests in rheumatology. Revista Brasileira de Reumatologia. 2009;49(4), 413-430. doi:10.1590/S0482-50042009000400008 Means R. Anemia of inflammation or chronic disease. The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center [internet]. 2018. Venables PJW. Diagnosis and differential diagnosis of rheumatoid arthritis. UpToDate [internet]. Updated 25 Nov 2019. Firestein GS, Budd R, Gabriel SE et al. Kelley's Textbook of Rheumatology E-Book. Elsevier Health Sciences. 2012. Abdelrahman MH, Mahdy S, Khanjar IA, et al. Prevalence of HLA-B27 in Patients with Ankylosing Spondylitis in Qatar. Int J Rheumatol. 2012;2012:860213. doi:10.1155/2012/860213 Frank J. Rheumatoid Arthritis (RA) Diagnosis. Arthritis Health [internet]. Updated 26 Aug 2016. Additional Reading The Primary Care Physician's Guide to Inflammatory Arthritis; Diagnosis. Rheumatology Network. June 2, 2010. http://www.rheumatologynetwork.com/articles/primary-care-physicians-guide-inflammatory-arthritis-diagnosis. Inflammatory Arthritis Center. Hospital for Special Surgery.http://www.hss.edu/inflammatory-arthritis-center.asp#.UzS4Q4VsJ4w. Kelley's Textbook of Rheumatology. Chapter 42. Polyarticular Arthritis. John J. Cush and Kathryn H. Dao. Ninth edition. Elsevier Saunders.