Monoarthritis with fever: Difference between revisions
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{{CMG}}; {{AE}}{{EG}} | {{CMG}}; {{AE}}{{EG}} | ||
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{| align="center" style="border: 0px; font-size: 90%; margin: 3px;" | {| align="center" style="border: 0px; font-size: 90%; margin: 3px;" | ||
! colspan="3" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Diseases | ! colspan="3" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Diseases | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Other | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Other | ||
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! rowspan=" | ! rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Monoarthritis | ||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infection]] | |||
! | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gonococcal infection]]<ref name="pmid12787521">{{cite journal |vauthors=Bardin T |title=Gonococcal arthritis |journal=Best Pract Res Clin Rheumatol |volume=17 |issue=2 |pages=201–8 |date=April 2003 |pmid=12787521 |doi= |url=}}</ref> | ||
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![[Dermatitis]], [[Tenosynovitis]] | ![[Dermatitis]], [[Tenosynovitis]] | ||
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![[Nongonococcal urethritis|Nongonococcal bacterial infections]]<ref name="pmid194809972">{{cite journal |vauthors=García-De La Torre I, Nava-Zavala A |title=Gonococcal and nongonococcal arthritis |journal=Rheum. Dis. Clin. North Am. |volume=35 |issue=1 |pages=63–73 |date=February 2009 |pmid=19480997 |doi=10.1016/j.rdc.2009.03.001 |url=}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Nongonococcal urethritis|Nongonococcal bacterial infections]]<ref name="pmid194809972">{{cite journal |vauthors=García-De La Torre I, Nava-Zavala A |title=Gonococcal and nongonococcal arthritis |journal=Rheum. Dis. Clin. North Am. |volume=35 |issue=1 |pages=63–73 |date=February 2009 |pmid=19480997 |doi=10.1016/j.rdc.2009.03.001 |url=}}</ref> | ||
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![[Limp|Limping]], [[Malaise]] | ![[Limp|Limping]], [[Malaise]] | ||
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![[Mycobacterial infection]]<ref name="pmid16297734">{{cite journal |vauthors=Gardam M, Lim S |title=Mycobacterial osteomyelitis and arthritis |journal=Infect. Dis. Clin. North Am. |volume=19 |issue=4 |pages=819–30 |date=December 2005 |pmid=16297734 |doi=10.1016/j.idc.2005.07.008 |url=}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mycobacterial infection]]<ref name="pmid16297734">{{cite journal |vauthors=Gardam M, Lim S |title=Mycobacterial osteomyelitis and arthritis |journal=Infect. Dis. Clin. North Am. |volume=19 |issue=4 |pages=819–30 |date=December 2005 |pmid=16297734 |doi=10.1016/j.idc.2005.07.008 |url=}}</ref> | ||
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![[Limp|Limping]], [[Malaise]], [[Chronic cough]] | ![[Limp|Limping]], [[Malaise]], [[Chronic cough]] | ||
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![[Fungal infection]]<ref name="pmid1616344">{{cite journal| author=Cuéllar ML, Silveira LH, Espinoza LR| title=Fungal arthritis. | journal=Ann Rheum Dis | year= 1992 | volume= 51 | issue= 5 | pages= 690-7 | pmid=1616344 | doi= | pmc=1005712 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1616344 }}</ref> | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Fungal infection]]<ref name="pmid1616344">{{cite journal| author=Cuéllar ML, Silveira LH, Espinoza LR| title=Fungal arthritis. | journal=Ann Rheum Dis | year= 1992 | volume= 51 | issue= 5 | pages= 690-7 | pmid=1616344 | doi= | pmc=1005712 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1616344 }}</ref> | ||
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![[Malaise]], [[Tenderness]] | ![[Malaise]], [[Tenderness]] | ||
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![[Lyme disease]]<ref name="pmid25999223">{{cite journal| author=Arvikar SL, Steere AC| title=Diagnosis and treatment of Lyme arthritis. | journal=Infect Dis Clin North Am | year= 2015 | volume= 29 | issue= 2 | pages= 269-80 | pmid=25999223 | doi=10.1016/j.idc.2015.02.004 | pmc=4443866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25999223 }}</ref> | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lyme disease]]<ref name="pmid25999223">{{cite journal| author=Arvikar SL, Steere AC| title=Diagnosis and treatment of Lyme arthritis. | journal=Infect Dis Clin North Am | year= 2015 | volume= 29 | issue= 2 | pages= 269-80 | pmid=25999223 | doi=10.1016/j.idc.2015.02.004 | pmc=4443866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25999223 }}</ref> | ||
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![[Erythema migrans]] | ![[Erythema migrans]] | ||
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! | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Crystal arthritis|Crystal-induced arthritis]] | ||
![[Gout]]<ref name="pmid62879632">{{cite journal |vauthors=Reginato A, Paul H, Schumacher HR |title=Crystal-induced arthritis |journal=Arch Phys Med Rehabil |volume=63 |issue=9 |pages=401–8 |date=September 1982 |pmid=6287963 |doi= |url=}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gout]]<ref name="pmid62879632">{{cite journal |vauthors=Reginato A, Paul H, Schumacher HR |title=Crystal-induced arthritis |journal=Arch Phys Med Rehabil |volume=63 |issue=9 |pages=401–8 |date=September 1982 |pmid=6287963 |doi= |url=}}</ref> | ||
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![[Conjunctival|Conjunctival nodules]] | ![[Conjunctival|Conjunctival nodules]] | ||
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! | ! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic|Systemic disorders]] | ||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[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> | |||
![[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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! | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[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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! | ! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myelodysplastic syndrome|Myelodysplastic]] and [[leukemic]] disorders<ref name="pmid24378738">{{cite journal| author=Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L et al.| title=Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 1 | pages= 1-10 | pmid=24378738 | doi=10.1097/MD.0000000000000011 | pmc=4616329 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24378738 }}</ref> | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] |
Revision as of 18:28, 3 May 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
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 | Infection | Gonococcal infection[1] | + | + | - | - | - | + | Maculopapular, Pustular, Vesicular lesions on an erythematous base | Leukocytosis | ↑ | Purulent with cell count > 50,000 WBC/µL (with PMNs > 90%) | Blood and synovial fluid culture | Minor articular damage | - | - | Dermal vasculitis with perivascular neutrophils | Nucleic acid amplification tests (NAATs) | Dermatitis, Tenosynovitis |
Nongonococcal bacterial infections[2] | + | + | - | - | - | + | Local erythema | Leukocytosis | ↑ | Purulent with cell count > 50,000 WBC/µL (with PMNs > 90%) | Blood and synovial fluid culture | Joint effusion, Cartilage destruction, Joint space narrowing | Sternoclavicular or sacroiliac joint infections | Periarticular osteomyelitis in MRI | - | Synovial fluid culture | Limping, Malaise | ||
Mycobacterial infection[3] | - | + | + | + | +/- | - | Local erythema | Leukocytosis, Normocytic normochromic anemia | ↑ | Moderately elevated WBC counts (neutrophilic predominance), low glucose, and increased protein | PPD | Tissue swelling, Bone destruction with normal joint space, Osteopenia | Vertebral anterior portion collapse | Complicated effusion with partial joint destruction and erosion in MRI | Granulomatous inflammation | Synovial fluid culture | Limping, Malaise, Chronic cough | ||
Fungal infection[4] | - | +/- | - | - | - | +/- | Local eczema, Local erythema | Eosinophilia, Leukocytosis | ↑ | WBC counts range from 9,000-43,000/µL (PMNs predominance) | Direct microscopy | Joint effusion, Dislocation of the joint, Metaphyseal irregularities and punched out lesions | Articular erosion | - | Villonodular synovitis, Typical pannus, Non-caseating granulomas, Spherules containing coccidioidal endospores | Synovial histopathology | Malaise, Tenderness | ||
Lyme disease[5] | + | + | +/- | +/- | - | - | Erythema migrans | Leukopenia, Thrombocytopenia | - | Cell counts 500-98,000/µL | Microscopic hematuria, Proteinuria, ↑ALT or AST | Knee joint effusion. Intra-articular edema | - | Unspecific effusion, Synovial thickening or enhancement in MRI | Fibrosis of the deeper dermis and hyalinization of collagen bundles | Serologic tests | Erythema migrans | ||
Crystal-induced arthritis | Gout[6] | + | +/- | - | - | - | + | Local swelling and erythema | Leukocytosis | ↑ | Needle shaped urate crystals, WBC count > 2000/µL | Urinary uric acid (>1100 mg in 24h) | Punched-out erosions or lyticareas with overhanging edges | Complementary for recognizing erosions | Tophi or edema in MRI | Large pale pink acellular areas (urate crystals), surrounded by histiocytes and multinucleated giant cells | Synovial fluid microscopy | Conjunctival nodules | |
Systemic disorders | Reactive arthritis[7] | +/- | +/- | - | - | - | - | 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 | |
Inflammatory bowel disease-associated arthritis[8] | + | + | - | - | + | +/- | 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 | ||
Myelodysplastic and leukemic disorders[9] | + | + | + | +/- | - | - | Petechia and purpura | Anemia, | ↑ | WBC count >2000/µL (inflammatory), with neutrophilpredominance | LDH, Uric acid | Articular surface erosion, Synovial effusion | Thickened synovium | Synovitis in MRI | Inflammatory cells infiltration in synovial tissue | Bone marrow biopsy | Fatigue, Nausea, Recurrent infections |
References
- ↑ Bardin T (April 2003). "Gonococcal arthritis". Best Pract Res Clin Rheumatol. 17 (2): 201–8. PMID 12787521.
- ↑ García-De La Torre I, Nava-Zavala A (February 2009). "Gonococcal and nongonococcal arthritis". Rheum. Dis. Clin. North Am. 35 (1): 63–73. doi:10.1016/j.rdc.2009.03.001. PMID 19480997.
- ↑ Gardam M, Lim S (December 2005). "Mycobacterial osteomyelitis and arthritis". Infect. Dis. Clin. North Am. 19 (4): 819–30. doi:10.1016/j.idc.2005.07.008. PMID 16297734.
- ↑ Cuéllar ML, Silveira LH, Espinoza LR (1992). "Fungal arthritis". Ann Rheum Dis. 51 (5): 690–7. PMC 1005712. PMID 1616344.
- ↑ Arvikar SL, Steere AC (2015). "Diagnosis and treatment of Lyme arthritis". Infect Dis Clin North Am. 29 (2): 269–80. doi:10.1016/j.idc.2015.02.004. PMC 4443866. PMID 25999223.
- ↑ Reginato A, Paul H, Schumacher HR (September 1982). "Crystal-induced arthritis". Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.
- ↑ 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.
- ↑ Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
- ↑ Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L; et al. (2014). "Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases". Medicine (Baltimore). 93 (1): 1–10. doi:10.1097/MD.0000000000000011. PMC 4616329. PMID 24378738.