Monoarthritis with local erythema: 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="8" 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>
! 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>
!+
!+
Line 71: Line 53:
![[Deformity]], Severe [[pain]]
![[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>
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infection]]
!+
!-
!+
!+/-
!-
!-
![[Rash]]
![[Normocytic normochromic anemia]]
!↑
! High [[WBC]] count (10,000-40,000/µL)
![[Hypercalcemia]], [[Hyperphosphatemia]]
!Peri-[[articular]] [[Osteoblastic sarcoma|osteoblastic]] or [[Osteoclast|osteoclastic]] lesion
!Elevation of the [[periosteum]]
!Intense [[radionuclide]] uptake in [[bone scan]]
!Spindle-shaped and atypical [[Stromal cell|stromal cells]], with irregular [[nuclei]]
!Clinical findings and imaging
![[Pain|Nocturnal pain]], [[Pathological|Pathologic fractures]]
|-
! 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>
! 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>
!+
!+
Line 128: Line 91:
![[Synovial fluid]] culture
![[Synovial fluid]] culture
![[Limp|Limping]], [[Malaise]]
![[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>
!-
!+
!+
!+
!+/-
!-
!Local [[erythema]]
![[Leukocytosis]], [[Normocytic normochromic anemia]]
!↑
!Moderately elevated [[WBC]] counts ([[Neutrophil|neutrophilic]] predominance), low [[glucose]], and increased [[protein]]
![[PPD-tuberculin skin test|PPD]]
! Tissue swelling,  [[Bone]] destruction with normal [[joint]] space, [[Osteopenia]]
![[Vertebral]] anterior portion collapse
!Complicated effusion with partial [[joint]] destruction and [[Erosion (dental)|erosion]] in [[MRI]]
![[Granulomatous]] [[inflammation]]
![[Synovial fluid]] culture
![[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>
! 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>
Line 166: Line 110:
![[Synovial]] [[histopathology]]
![[Synovial]] [[histopathology]]
![[Malaise]], [[Tenderness]]
![[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>
!+
!+
!+/-
!+/-
!-
!-
![[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
![[Serological testing|Serologic '''tests''']]
![[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" |[[Crystal arthritis|Crystal-induced arthritis]]
Line 225: Line 150:
![[Tenderness]]
![[Tenderness]]
|-
|-
! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic|Systemic disorders]]
! rowspan="2" 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>
! 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>
!+
!+
Line 285: Line 191:
!Clinical findings and history
!Clinical findings and history
![[Anterior uveitis|Acute anterior uveitis]]
![[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>
!+
!-
!+
!+
!+
!-
![[Rheumatoid nodules]]
![[Anemia]], [[Thrombocytosis]]
!↑
![[WBC]] count >2000/µL (generally 5000-50,000/µL), with [[neutrophil]]<nowiki/>predominance (60-80%)
![[Anti-citrullinated protein antibody|Anti-CCP Ab]], [[Hyperuricemia]]
![[Joint]]-space narrowing
![[Fractures|Microfractures]]
![[Synovitis]] in [[MRI]]
!Influx of [[inflammatory cells]] into the [[synovial membrane]], with[[angiogenesis]]
!Clinical findings coupled [[Anti-citrullinated protein antibody|anti-CCP antibody]]
![[Rheumatoid nodules]]
|-
! 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>
!+
!+
!+
!+/-
!-
!-
![[Petechia]] and [[purpura]]
![[Anemia]],
[[Leukocytosis]],
[[Thrombocytopenia]]
!↑
![[WBC]] count >2000/µL ([[inflammatory]]), with [[neutrophil]]<nowiki/>predominance
![[LDH]], [[Uric acid]]
![[Articular]] surface erosion, [[Synovial]] effusion
!Thickened [[synovium]]
![[Synovitis]] in [[MRI]]
![[Inflammatory cells]] [[Infiltration (medical)|infiltration]] in synovial tissue
![[Bone marrow biopsy]]
![[Fatigue]], [[Nausea]], Recurrent [[infections]]
|-
|-
|}
|}
 
</small>
==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Rheumatology]]
[[Category:Rheumatology]]

Revision as of 18:41, 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 Trauma[1] + - - - - + Wound or laceration - - Hemarthrosis - Severe joint effusion, Fracture Fracture, Synovial tear - - X-ray Deformity, Severe pain
Infection Gonococcal infection[2] + + - - - + 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[3] + + - - - + 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
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
Crystal-induced arthritis Gout[5] + +/- - - - + 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
Pseudo-gout[6] + - - - - +/- Local swelling and erythema Leukocytosis ↑ Rod shaped 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 calcific deposits in ultrasonography Synovial calcium pyrophosphate crystals Synovial fluid microscopy Tenderness
Systemic disorders Psoriatic arthritis[7] + - - - - + 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 Ig and RF, Greater propensity for fibrous ankylosis, osseous resorption, and heterotopic bone formation Clinical findings Onycholysis, Splinter hemorrhages
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

References

  1. ↑ Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F; et al. (2016). "Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation". RMD Open. 2 (2): e000279. doi:10.1136/rmdopen-2016-000279. PMC 5013366. PMID 27651925.
  2. ↑ Bardin T (April 2003). "Gonococcal arthritis". Best Pract Res Clin Rheumatol. 17 (2): 201–8. PMID 12787521.
  3. ↑ 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.
  4. ↑ Cuéllar ML, Silveira LH, Espinoza LR (1992). "Fungal arthritis". Ann Rheum Dis. 51 (5): 690–7. PMC 1005712. PMID 1616344.
  5. ↑ Reginato A, Paul H, Schumacher HR (September 1982). "Crystal-induced arthritis". Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.
  6. ↑ Macmullan P, McCarthy G (2012). "Treatment and management of pseudogout: insights for the clinician". Ther Adv Musculoskelet Dis. 4 (2): 121–31. doi:10.1177/1759720X11432559. PMC 3383522. PMID 22870500.
  7. ↑ 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.
  8. ↑ Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
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