Monoarthritis with claudication: Difference between revisions

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


<small>
{| 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
Line 32: Line 33:
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
|-
|-
! rowspan="16" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Monoarthritis
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Monoarthritis
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Osteoarthritis]]<ref name="pmid28149655">{{cite journal| author=Chen D, Shen J, Zhao W, Wang T, Han L, Hamilton JL et al.| title=Osteoarthritis: toward a comprehensive understanding of pathological mechanism. | journal=Bone Res | year= 2017 | volume= 5 | issue=  | pages= 16044 | pmid=28149655 | doi=10.1038/boneres.2016.44 | pmc=5240031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28149655  }}</ref>
!+
!-
!-
!-
!-
!-
![[Heberden's node|Heberden nodes]]
![[Anemia]]
!-
!Noninflammatory joint fluid
!Urinary [[pyridinium]] cross-links
!Joint-space loss, Subchondral bony [[sclerosis]], Cyst formation
!Malalignment of the patellofemoral [[joint]]
!Early diagnosis of [[osteoarthritis]] of the hand with [[bone scan]]
!-
!Clinical findings
!Microfracture, [[Bone pain]]
|-
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Trauma]]<ref name="pmid27651925">{{cite journal| author=Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F et al.| title=Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. | journal=RMD Open | year= 2016 | volume= 2 | issue= 2 | pages= e000279 | pmid=27651925 | doi=10.1136/rmdopen-2016-000279 | pmc=5013366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27651925  }}</ref>
!+
!-
!-
!-
!-
!+
![[Wound]] or [[laceration]]
!-
!-
![[Hemarthrosis]]
!-
!Severe joint effusion, [[Bone fracture|Fracture]]
!Fracture, Synovial tear
!-
!-
![[X-ray]]
![[Deformity]], Severe [[pain]]
|-
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neoplasms]]<ref name="pmid17915099">{{cite journal |vauthors=Askling J |title=Malignancy and rheumatoid arthritis |journal=Curr Rheumatol Rep |volume=9 |issue=5 |pages=421–6 |date=October 2007 |pmid=17915099 |doi= |url=}}</ref>
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neoplasms]]<ref name="pmid17915099">{{cite journal |vauthors=Askling J |title=Malignancy and rheumatoid arthritis |journal=Curr Rheumatol Rep |volume=9 |issue=5 |pages=421–6 |date=October 2007 |pmid=17915099 |doi= |url=}}</ref>
!+
!+
Line 90: Line 53:
![[Pain|Nocturnal pain]], [[Pathological|Pathologic fractures]]
![[Pain|Nocturnal pain]], [[Pathological|Pathologic fractures]]
|-
|-
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infection]]
! rowspan="2" 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>
!+
!+
!-
!-
!-
!+
![[Maculopapular]], [[Pustular rash|Pustular]], [[Vesicular]] lesions on an [[Erythematous|erythematous base]]
![[Leukocytosis]]
!↑
!Purulent with cell count > 50,000 [[WBC]]/µL (with PMNs > 90%)
![[Blood culture|Blood]] and [[Synovial fluid|synovial fluid culture]]
!Minor [[articular]] damage
!-
!-
!Dermal [[vasculitis]] with perivascular [[neutrophils]]
![[Nucleic acid amplification technique|Nucleic acid amplification tests (NAATs)]]
![[Dermatitis]], [[Tenosynovitis]]
|-
! 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>
!+
!+
!-
!-
!-
!+
!Local [[erythema]]
![[Leukocytosis]]
!↑
!Purulent with cell count > 50,000 [[WBC]]/µL (with PMNs > 90%)
![[Blood culture|Blood]] and [[Synovial fluid|synovial fluid culture]]
![[Joint]] effusion, [[Cartilage injuries|Cartilage destruction]], Joint space narrowing
![[Sternoclavicular joint|Sternoclavicular]] or [[sacroiliac joint]] infections
!Periarticular [[osteomyelitis]] in [[MRI]]
!-
![[Synovial fluid]] culture
![[Limp|Limping]], [[Malaise]]
|-
! 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>
! 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>
!-
!-
Line 147: Line 72:
![[Synovial fluid]] culture
![[Synovial fluid]] culture
![[Limp|Limping]], [[Malaise]], [[Chronic cough]]
![[Limp|Limping]], [[Malaise]], [[Chronic cough]]
|-
! 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>
!-
!+/-
!-
!-
!-
!+/-
!Local [[eczema]], Local [[erythema]]
![[Eosinophilia]], [[Leukocytosis]]
!↑
![[WBC]] counts range from 9,000-43,000/µL ([[PMNs]] predominance)
!Direct [[microscopy]]
![[Joint]] effusion, [[Joint dislocation|Dislocation of the joint]], [[Metaphyseal]] irregularities and punched out lesions
![[Articular]] erosion
!-
!Villonodular [[synovitis]], Typical [[pannus]], Non-[[Caseous necrosis|caseating granulomas]], Spherules containing [[Coccidioides spp|coccidioidal endospores]]
![[Synovial]] [[histopathology]]
![[Malaise]], [[Tenderness]]
|-
|-
! 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>
! 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>
Line 186: Line 92:
![[Erythema migrans]]
![[Erythema migrans]]
|-
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Crystal arthritis|Crystal-induced arthritis]]
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic|Systemic disorders]]
! 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>
!+
!+/-
!-
!-
!-
!+
!Local [[swelling]] and [[erythema]]
![[Leukocytosis]]
!↑
!Needle shaped [[urate]] crystals, [[WBC]] count > 2000/µL
!Urinary [[uric acid]] (>1100 mg in 24h)
!Punched-out erosions or [[lytic]]<nowiki/>areas with overhanging edges 
!Complementary for recognizing [[Erosion (dental)|erosions]]
![[Tophus|Tophi]] or [[edema]] in [[MRI]]
!Large pale pink acellular areas ([[Uric acid|urate crystals]]), surrounded by [[histiocytes]] and [[multinucleated giant cells]]
![[Synovial fluid]] microscopy
![[Conjunctival|Conjunctival nodules]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pseudogout|Pseudo-gout]]<ref name="pmid22870500">{{cite journal| author=Macmullan P, McCarthy G| title=Treatment and management of pseudogout: insights for the clinician. | journal=Ther Adv Musculoskelet Dis | year= 2012 | volume= 4 | issue= 2 | pages= 121-31 | pmid=22870500 | doi=10.1177/1759720X11432559 | pmc=3383522 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22870500  }}</ref>
!+
!-
!-
!-
!-
!+/-
!Local [[swelling]] and [[erythema]]
![[Leukocytosis]]
!↑
!Rod shaped [[Calcium pyrophosphate deposition disease|CPPD crystals]], [[WBC]] count > 2000/µL
![[Hypercalcemia]], [[Hypercalciuria]]
!Radiodense lines paralleling the [[articular]] surface and [[calcification]] ([[chondrocalcinosis]])
!Calcific mass with a lobulated configuration in the [[ligamentum flavum]] or the [[joint capsule]]
![[Synovitis]] and [[Calcification|calcific]] deposits in [[ultrasonography]]
!Synovial [[Calcium pyrophosphate|calcium pyrophosphate crystals]]
![[Synovial fluid]] microscopy
![[Tenderness]]
|-
! rowspan="6" 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>
!+/-
!+/-
!-
!-
!-
!-
![[Genital]] [[ulceration]]
![[Normocytic normochromic anemia]]
!↑
! High [[WBC]] count (10,000-40,000/µL)
! [[HLA-B27|HLA-B27 test]] 
![[Periosteal reaction]] and proliferation of [[Enthesitis|tendon insertion site]]
![[Sacroiliitis]]
![[Enthesitis]] in [[ultrasonography]]
![[Keratoderma blennorrhagica|Keratoderma blennorrhagicum]],[[Balanitis circinata]] 
! [[Spondyloarthritis]] and unequivocal demonstration of preceding infection
![[Conjunctivitis]], [[Uveitis]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[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>
!+
!-
!-
!-
!-
!+
!Scaly [[Erythematous rash|erythematous plaques]],
[[Guttate psoriasis|Guttate lesions]], Lakes of [[pus]],
 
[[Erythroderma]]
!Normal
!↑
!High [[WBC]] count (5000-15,000/µL) with >50% of [[PMN|PMN leukocytes]]
!↑[[RF]], [[ANA]], [[IgA]]
![[Joint]]-space narrowing, [[Periostitis|Fluffy periostitis]]
!Pencil-in-cup deformity, Early signs of [[synovitis]]
![[Synovitis|Sacroiliitic synovitis]], [[Enthesitis]] in [[MRI]]
!Lack of intrasynovial [[Immunoglobulin A|Ig]] and [[RF]], Greater propensity for [[Ankylosis|fibrous ankylosis]], [[Osseous|osseous resorption]], and [[Heterotopic ossification|heterotopic bone formation]]
!Clinical findings
![[Onycholysis]], [[Splinter hemorrhage|Splinter hemorrhages]]
|-
! 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>
!+
!+
!-
!-
!+
!+/-
![[Pyoderma gangrenosum]]([[ulcerative colitis]]),[[Erythema nodosum]]([[Crohn disease]])
![[Iron deficiency anemia]], [[Leukocytosis]], [[Thrombocytosis]]
!↑
!Mild to moderate [[Inflammatory|inflammatory fluid]], [[PMN]]<nowiki/>predominance
!↑[[RF]], [[Endomysium|Antiendomysial Ab]],[[Anti-transglutaminase antibodies|Antitransglutaminase Ab]]
!Bilateral [[sacroiliitis]], Syndesmophytes and apophyseal joint involvement in [[spine]]
!-
!Early detection of [[Spinal stenosis|spinal]] and [[Sacroiliac joint|sacroiliac lesions]] in [[MRI]]
!-
!Clinical findings and history
![[Anterior uveitis|Acute anterior uveitis]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[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>
!+
!-
!-
!-
!-
!-
!Mild [[papules]] and [[nodules]]
!Mild [[anemia]]
!↑
!Cell count < 25% [[PMNs]] (non-[[inflammatory]])
! [[IL-2]] and [[Interferon gamma|IFN-γ]], ↑[[Angiotensin-converting enzyme|ACE]], ↑[[Vitamin D|1, 25-dihydroxyvitamin D]]
!Bilateral [[Adenopathy|hilar adenopathy]]
!Active [[alveolitis]] or [[fibrosis]]
![[Hepatosplenomegaly]] in [[ultrasonography]]
![[Granuloma|Noncaseating granulomas (NCGs)]]
![[Histopathology|Histological confirmation]]
![[Heart block]], [[Ocular disease|Ocular lesion]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[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>
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[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>
!+
!+
Line 347: Line 135:
|-
|-
|}
|}
 
</small>
==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Rheumatology]]
[[Category:Rheumatology]]

Revision as of 18:34, 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 Neoplasms[1] + - + +/- - - Rash Normocytic normochromic anemia ↑  High WBC count (10,000-40,000/µL) Hypercalcemia, Hyperphosphatemia Peri-articular osteoblastic or osteoclastic lesion Elevation of the periosteum Intense radionuclide uptake in bone scan Spindle-shaped and atypical stromal cells, with irregular nuclei Clinical findings and imaging Nocturnal pain, Pathologic fractures
Infection Mycobacterial infection[2] - + + + +/- - 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
Lyme disease[3] + + +/- +/- - - 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
Systemic disorders Rheumatoid arthritis[4] + - + + + - 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[5] + + + +/- - - Petechia and purpura Anemia,

Leukocytosis,

Thrombocytopenia

↑ 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

  1. ↑ Askling J (October 2007). "Malignancy and rheumatoid arthritis". Curr Rheumatol Rep. 9 (5): 421–6. PMID 17915099.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
  5. ↑ 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.
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