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 Diseases That Cause 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)	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^[4]	+/-	+/-	-	-	-	-	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
		Enteric infection^[5]	-	+	-	-	-	-	Keratoderma and psoriaform lesions, Erythema nodosum	Neutrophilia	↑	PCR of causative organism	Stool exam and culture	-	-	-	Neutrophilic infiltration in synovial tissues	PCR of causative organism in synovial fluid	Diarrhea, Enthesopathy
	Other seronegative spondyloarthritides	Ankylosing spondylitis^[6]	+	-	+/-	+/-	+	-	Dactylitis (sausage digit)	Normocytic normochromic anemia	↑	High WBC count (lymphocyte predominance)	↑Alkaline phosphatase (ALP)	Bony erosions and sclerosis of the joints	Early sacroiliitis, erosions, and enthesitis	Possible cauda equina syndrome secondary to spinal stenosis in MRI	Chronic inflammation with CD4⁺ and CD8⁺ T lymphocytes and macrophages	Plain x-rays	Peripheral enthesitis, Uveitis
		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^[8]	+	+	-	-	+	+/-	Pyoderma gangrenosum (ulcerative colitis), Erythema nodosum (Crohn disease)	Iron deficiency anemia, Leukocytosis, Thrombocytosis	↑	Mild to moderate inflammatory fluid, PMN predominance	↑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
	Rheumatoid arthritis^[9]		+	-	+	+	+	-	Rheumatoid nodules	Anemia, Thrombocytosis	↑	WBC count >2000/µL (generally 5000-50,000/µL), with neutrophil predominance (60-80%)	Anti-CCP Ab, Hyperuricemia	Joint-space narrowing	Microfractures	Synovitis in MRI	Influx of inflammatory cells into the synovial membrane, with angiogenesis	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.
↑ 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.
↑ Hill Gaston, J (2003). "Arthritis associated with enteric infection". Best Practice & Research Clinical Rheumatology. 17 (2): 219–239. doi:10.1016/S1521-6942(02)00104-3. ISSN 1521-6942.
↑ McVeigh CM, Cairns AP (2006). "Diagnosis and management of ankylosing spondylitis". BMJ. 333 (7568): 581–5. doi:10.1136/bmj.38954.689583.DE. PMC 1570004. PMID 16974012.
↑ 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.
↑ Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.

Template:WH Template:WS

[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.

[pmid15084505-4] 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.

[Hill_Gaston2003-5] Hill Gaston, J (2003). "Arthritis associated with enteric infection". Best Practice & Research Clinical Rheumatology. 17 (2): 219–239. doi:10.1016/S1521-6942(02)00104-3. ISSN 1521-6942.

[pmid16974012-6] McVeigh CM, Cairns AP (2006). "Diagnosis and management of ankylosing spondylitis". BMJ. 333 (7568): 581–5. doi:10.1136/bmj.38954.689583.DE. PMC 1570004. PMID 16974012.

[pmid23493653-7] 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.

[pmid22933865-8] Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.

[pmid24024009-9] Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.

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Polyarthritis

Overview

Causes

Differential Diagnosis of Diseases That Cause Polyarthritis

References

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