Monoarthritis: Difference between revisions

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__NOTOC__
__NOTOC__
{{CMG}}; {{AE}}{{EG}}
{{CMG}}; {{AE}}{{EG}}


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! rowspan="16" |Monoarthritis
! rowspan="16" |Monoarthritis
! colspan="2" |Osteoarthritis 
! colspan="2" |[[Osteoarthritis]] 
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! colspan="2" |Trauma
! colspan="2" |[[Trauma]]
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! colspan="2" |Neoplasms 
! colspan="2" |[[Neoplasms]] 
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! rowspan="5" |Infection
! rowspan="5" |[[Infection]]
!Gonococcal infection
![[Gonococcal infection]]
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!Nongonococcal bacterial infections
![[Nongonococcal urethritis|Nongonococcal bacterial infections]]
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!Mycobacterial infection
![[Mycobacterial infection]]
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!Fungal infection
![[Fungal infection]]
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!Lyme disease
![[Lyme disease]]
!+
!+
!+
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|[[Erythema migrans]]
|[[Erythema migrans]]
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! rowspan="2" |Crystal-induced arthritis
! rowspan="2" |[[Crystal arthritis|Crystal-induced arthritis]]
!Gout
![[Gout]]
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!Pseudo-gout
![[Pseudogout|Pseudo-gout]]
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! rowspan="6" |Systemic disorders
! rowspan="6" |[[Systemic|Systemic disorders]]
!Reactive arthritis
![[Reactive arthritis]]<ref name="pmid15084505">{{cite journal| author=Colmegna I, Cuchacovich R, Espinoza LR| title=HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. | journal=Clin Microbiol Rev | year= 2004 | volume= 17 | issue= 2 | pages= 348-69 | pmid=15084505 | doi= | pmc=387405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15084505  }}</ref>
!+/-
!+/-
!+/-
!+/-
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![[Conjunctivitis]], [[Uveitis]]
![[Conjunctivitis]], [[Uveitis]]
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!Psoriatic arthritis
![[Psoriatic arthritis]]<ref name="pmid23493653">{{cite journal| author=Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J| title=Psoriatic arthritis. | journal=Pol J Radiol | year= 2013 | volume= 78 | issue= 1 | pages= 7-17 | pmid=23493653 | doi=10.12659/PJR.883763 | pmc=3596149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23493653  }}</ref>
!+
!+
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!-
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![[Onycholysis]], [[Splinter hemorrhage|Splinter hemorrhages]]
![[Onycholysis]], [[Splinter hemorrhage|Splinter hemorrhages]]
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!Inflammatory bowel disease-associated arthritis
![[Inflammatory bowel disease]]-associated [[arthritis]]<ref name="pmid22933865">{{cite journal| author=Orchard TR| title=Management of arthritis in patients with inflammatory bowel disease. | journal=Gastroenterol Hepatol (N Y) | year= 2012 | volume= 8 | issue= 5 | pages= 327-9 | pmid=22933865 | doi= | pmc=3424429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22933865  }}</ref>
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![[Anterior uveitis|Acute anterior uveitis]]
![[Anterior uveitis|Acute anterior uveitis]]
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!Sarcoid periarthritis
![[Sarcoidosis|Sarcoid]] periarthritis<ref name="pmid18032765">{{cite journal |vauthors=Iannuzzi MC, Rybicki BA, Teirstein AS |title=Sarcoidosis |journal=N. Engl. J. Med. |volume=357 |issue=21 |pages=2153–65 |date=November 2007 |pmid=18032765 |doi=10.1056/NEJMra071714 |url=}}</ref>
!+
!+
!-
!-
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![[Heart block]], [[Ocular disease|Ocular lesion]]
![[Heart block]], [[Ocular disease|Ocular lesion]]
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!Rheumatoid arthritis
![[Rheumatoid arthritis]]<ref name="pmid24024009">{{cite journal| author=Heidari B| title=Rheumatoid Arthritis: Early diagnosis and treatment outcomes. | journal=Caspian J Intern Med | year= 2011 | volume= 2 | issue= 1 | pages= 161-70 | pmid=24024009 | doi= | pmc=3766928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24024009  }}</ref>
!+
!+
!-
!-
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![[Rheumatoid nodules]]
![[Rheumatoid nodules]]
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!Myelodysplastic and leukemic disorders
![[Myelodysplastic syndrome|Myelodysplastic]] and [[leukemic]] disorders
!
!
!
!

Revision as of 19:25, 30 April 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Differential Diagnosis of Monoarthritis

Differentiating the diseases that can cause monoathritis:

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Joint Swelling Fever Weight loss Claudication Morning stiffness Local erythema Skin manifestation CBC ESR Synovial fluid Other X-ray CT scan Other
Monoarthritis Osteoarthritis 
Trauma
Neoplasms 
Infection Gonococcal infection
Nongonococcal bacterial infections
Mycobacterial infection
Fungal infection
Lyme disease + + +/- +/- - - Erythema migrans Leukopenia, Thrombocytopenia - Cell counts 500-98,000/µL Microscopic hematuria, Proteinuria, ↑ALT or AST - - - Fibrosis of the deeper dermis and hyalinization of collagen bundles Serologic tests Erythema migrans
Crystal-induced arthritis Gout
Pseudo-gout
Systemic disorders Reactive arthritis[1] +/- +/- - - - - Genital ulceration Normocytic normochromic anemia ↑  High WBC count (10,000-40,000/µL)  HLA-B27 test  Periosteal reaction and proliferation of tendon insertion site Sacroiliitis Enthesitis in ultrasonography Keratoderma blennorrhagicum,Balanitis circinata   Spondyloarthritis and unequivocal demonstration of preceding infection Conjunctivitis, Uveitis
Psoriatic arthritis[2] + - - - - + Scaly erythematous plaques,

Guttate lesions, Lakes of pus,

Erythroderma

Normal ↑ High WBC count (5000-15,000/µL) with >50% of PMN leukocytes ↑RF, ANA, IgA Joint-space narrowing, Fluffy periostitis Pencil-in-cup deformity, Early signs of synovitis Sacroiliitic synovitis, Enthesitis in MRI Lack of intrasynovial Igand RF, Greater propensity for fibrous ankylosis, osseous resorption, and heterotopic bone formation Clinical findings Onycholysis, Splinter hemorrhages
Inflammatory bowel disease-associated arthritis[3] + + - - + +/- Pyoderma gangrenosum(ulcerative colitis),Erythema nodosum(Crohn disease) Iron deficiency anemia, Leukocytosis, Thrombocytosis ↑ Mild to moderate inflammatory fluid, PMNpredominance ↑RF, Antiendomysial Ab,Antitransglutaminase Ab Bilateral sacroiliitis, Syndesmophytes and apophyseal joint involvement in spine - Early detection of spinal and sacroiliac lesions in MRI - Clinical findings and history Acute anterior uveitis
Sarcoid periarthritis[4] + - - - - - Mild papules and nodules Mild anemia ↑ Cell count < 25% PMNs (non-inflammatory)  IL-2 and IFN-γ, ↑ACE, ↑1, 25-dihydroxyvitamin D Bilateral hilar adenopathy Active alveolitis or fibrosis Hepatosplenomegaly in ultrasonography Noncaseating granulomas (NCGs) Histological confirmation Heart block, Ocular lesion
Rheumatoid arthritis[5] + - + + + - Rheumatoid nodules Anemia, Thrombocytosis ↑ WBC count >2000/µL (generally 5000-50,000/µL), with neutrophilpredominance (60-80%) Anti-CCP Ab, Hyperuricemia Joint-space narrowing Microfractures Synovitis in MRI Influx of inflammatory cells into the synovial membrane, withangiogenesis Clinical findings coupled anti-CCP antibody Rheumatoid nodules
Myelodysplastic and leukemic disorders

References

  1. ↑ Colmegna I, Cuchacovich R, Espinoza LR (2004). "HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations". Clin Microbiol Rev. 17 (2): 348–69. PMC 387405. PMID 15084505.
  2. ↑ Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J (2013). "Psoriatic arthritis". Pol J Radiol. 78 (1): 7–17. doi:10.12659/PJR.883763. PMC 3596149. PMID 23493653.
  3. ↑ Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
  4. ↑ Iannuzzi MC, Rybicki BA, Teirstein AS (November 2007). "Sarcoidosis". N. Engl. J. Med. 357 (21): 2153–65. doi:10.1056/NEJMra071714. PMID 18032765.
  5. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.


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