Polyarthritis with morning stiffness

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
Polyarthritis	Other seronegative spondyloarthritides	Ankylosing spondylitis	+	-	+/-	+/-	+	-	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
		Inflammatory bowel disease	+	+	-	-	+	+/-	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		+	-	+	+	+	-	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
	Systemic rheumatic illnesses	Still's disease	-	-	+/-	-	+/-	+	Mild papules and nodules	Anemia, Thrombocytosis	↑	High WBC count (5000-15,000/µL) with >50% of PMN leukocytes	ANA, RF	Soft tissue swelling, Osteopenia, Joint-space narrowing	Synovial inflammation	Inflamed synovium in ultrasonography	Inflammatory infiltration in synovium	Clinical findings and synovial fluid analysis	Ocular involvement
	Other systemic illnesses	Palindromic rheumatism	+	-	-	+/-	+	-	Rheumatoid nodules	Anemia	↑	High WBC count (5000-15,000/µL) with >50% of PMN leukocytes	RF, Anti-CCP antibody, ↑Cr or BUN, ↑ALT or AST, ANA	Effusions in joints	Microfractures	Basilar invagination with cranial migration of an eroded odontoid peg in MRI	Influx of inflammatory cells into the synovial membrane, withangiogenesis, proliferation of chronic inflammatory cells	Clinical findings coupled anti-CCP antibody	Rheumatoid nodules
Polyarticular pain	Fibromyalgia		-	-	-	+/-	+/-	-	Maculopapular rash	Normal	-	Normal	-	-	-	-	Mild inflammation	Clinical findings	Muscle pain