Polyarthritis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Polyarthritis is any type of arthritis which involves five or more joints - an inflammation of two, three or four joints is an oligoarthritis.

Causes

Polyarthritis is most often caused by an auto-immune disorder such as Rheumatoid arthritis, Psoriatic arthritis, and Lupus erythematosus but can also be caused by infections such as Ross River Virus.

Differential Diagnosis of Polyarthritis

			Symptoms				Physical examination			Lab Findings				Imaging			Histopathology
Diseases			Clinical manifestations							Para-clinical findings								Gold standard	Additional findings
			Symptoms				Physical examination			Para-clinical findings
			Joint Swelling	Fever	Weight loss	Claudication	Morning stiffness	Local erythema	Skin manifestation	CBC	ESR	Synovial fluid	Other	X-ray	CT scan	Other	Histopathology
Polyarthritis	Infectious arthritis	Lyme disease^[1]	+	+	+/-	+/-	-	-	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
	Infectious arthritis	Bacterial endocarditis^[2]	+	+	+	-	-	+/-	Janeway lesions, Osler nodes, Roth spots	Normochromic-normocytic anemia	↑	↑WBC, S. aureus in culture	Hyperglobulinemia, Cryoglobulinemia	Joint erosion and effusion	-	-	Vegetation or intracardiac abscess demonstrating active endocarditis	Echocardiography (TTE)	Janeway lesions, Osler nodes, Roth spots, Vertebral osteomyelitis
	Postinfectious (reactive) arthritis	Rheumatic fever^[3]	+	+	-	-	-	+/-	Erythema marginatum rheumaticum	Leukocytosis	↑	Sterile inflammatory reaction with cells<20,000/μL	Streptococcal antibody titer	Cardiomegaly	Valvular or pericardial calcification	Echocardiographic changes in heart valves	Edema, Fibrinoid necrosis, Mononuclear cell infiltrate	Echocardiography	Chorea, Carditis
		Reactive arthritis
		Enteric infection
	Other seronegative spondyloarthritides	Ankylosing spondylitis
		Psoriatic arthritis
		Inflammatory bowel disease
	Rheumatoid arthritis		+	-	+	+			Rheumatoid nodules	Anemia, Thrombocytosis	↑		Hyperuricemia, Arthrocentesis and synovial fluid analysis to exclude gout, Serologic studies		CT scan: Microfractures	MRI and ultrasound: Synovitis	Influx of inflammatory cells into the synovial membrane, with angiogenesis, proliferation of chronic inflammatory cells	Clinical findings coupled anti-CCP antibody	Rheumatoid nodules
	Inflammatory osteoarthritis
	Crystal-induced arthritis
	Systemic rheumatic illnesses	Systemic lupus erythematosus
		Systemic vasculitis
		Systemic sclerosis
		Polymyositis/dermatomyositis
		Still's disease
		Behçet's syndrome
		Relapsing polychondritis
	Other systemic illnesses	Sarcoidosis
		Palindromic rheumatism
		Familial Mediterranean fever
		Malignancy
		Hyperlipoproteinemias
Polyarticular pain	Viral arthritis	Hepatitis B and C
		Rubella
		Parvovirus
	Fibromyalgia
	Soft tissue abnormalities
	Hypothyroidism
	Neuropathic pain
	Metabolic bone disease
	Depression

References

↑ Lantos PM (2015). "Chronic Lyme disease". Infect Dis Clin North Am. 29 (2): 325–40. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.
↑ Soor P, Sharma N, Rao C (2017). "Multifocal Septic Arthritis Secondary to Infective Endocarditis: A Rare Case Report". J Orthop Case Rep. 7 (1): 65–68. doi:10.13107/jocr.2250-0685.692. PMC 5458702. PMID 28630844.
↑ Kumar RK, Tandon R (2013). "Rheumatic fever & rheumatic heart disease: the last 50 years". Indian J Med Res. 137 (4): 643–58. PMC 3724245. PMID 23703332.

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[pmid25999227-1] Lantos PM (2015). "Chronic Lyme disease". Infect Dis Clin North Am. 29 (2): 325–40. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.

[pmid28630844-2] Soor P, Sharma N, Rao C (2017). "Multifocal Septic Arthritis Secondary to Infective Endocarditis: A Rare Case Report". J Orthop Case Rep. 7 (1): 65–68. doi:10.13107/jocr.2250-0685.692. PMC 5458702. PMID 28630844.

[pmid23703332-3] Kumar RK, Tandon R (2013). "Rheumatic fever & rheumatic heart disease: the last 50 years". Indian J Med Res. 137 (4): 643–58. PMC 3724245. PMID 23703332.

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Polyarthritis

Overview

Causes

Differential Diagnosis of Polyarthritis

References

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