Polyarthritis

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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

Diseases			Clinical manifestations					Para-clinical findings						Gold standard	Additional findings
			Symptoms				Physical examination
								Lab Findings				Imaging	Histopathology
			Joint Swelling	Fever	Weight loss	Claudication		Biomarker	CBC	ESR	Other
Polyarthritis	Infectious arthritis	Lyme disease	+	+	+/-	+/-	Lyme encephalopathy, Acrodermatitis chronica atrophicans	CXCL9 (MIG), CXCL10 (IP-10) and CCL19 (MIP3B)	Leukopenia, Thrombocytopenia	-	Microscopic hematuria, Proteinuria, ↑ALT or AST	CT scan: Punctate lesions in periventricular white matter in brain SPECT	Acrodermatitis chronica atrophicans	Serologic tests	Erythema migrans
		Bacterial endocarditis	+	+	+	-	Janeway lesions, Osler nodes, Roth spots	NT-proBNP	Normochromic-normocytic anemia	↑	Hyperglobulinemia, Cryoglobulinemia	CT scan: Metastatic infections, such as splenic infarct, renal infarcts, or psoas abscess Echo: Vegetation, abscess, or new dehiscence of a prosthetic valvein echocardiography	Vegetation or intracardiac abscess demonstrating active endocarditis	Echocardiography (TTE)	Janeway lesions, Osler nodes, Roth spots, Vertebral osteomyelitis
	Postinfectious (reactive) arthritis	Rheumatic fever
		Reactive arthritis
		Enteric infection
	Other seronegative spondyloarthritides	Ankylosing spondylitis
		Psoriatic arthritis
		Inflammatory bowel disease
	Rheumatoid arthritis		+	-	+	+	Limited joint motion, Rheumatoid nodules	RF and anti-CCP antibodies	Anemia, Thrombocytosis	↑	Hyperuricemia, Arthrocentesis and synovial fluid analysis to exclude gout, Serologic studies	MRI and ultrasound: Synovitis CT scan: Microfractures	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
		Autoinflammatory disorders
	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