Monoarthritis with fever

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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 Infection Gonococcal infection[1] + + - - - + 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[2] + + - - - + 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
Mycobacterial infection[3] - + + + +/- - Local erythema Leukocytosis, Normocytic normochromic anemia ↑ Moderately elevated WBC counts (neutrophilic predominance), low glucose, and increased protein PPD  Tissue swelling, Bone destruction with normal joint space, Osteopenia Vertebral anterior portion collapse Complicated effusion with partial joint destruction and erosion in MRI Granulomatous inflammation Synovial fluid culture Limping, Malaise, Chronic cough
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
Lyme disease[5] + + +/- +/- - - 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 Serologic tests Erythema migrans
Crystal-induced arthritis Gout[6] + +/- - - - + 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
Systemic disorders Reactive arthritis[7] +/- +/- - - - - 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
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
Myelodysplastic and leukemic disorders[9] + + + +/- - - Petechia and purpura Anemia,

Leukocytosis,

Thrombocytopenia

↑ WBC count >2000/µL (inflammatory), with neutrophilpredominance LDH, Uric acid Articular surface erosion, Synovial effusion Thickened synovium Synovitis in MRI Inflammatory cells infiltration in synovial tissue Bone marrow biopsy Fatigue, Nausea, Recurrent infections

References

  1. ↑ Bardin T (April 2003). "Gonococcal arthritis". Best Pract Res Clin Rheumatol. 17 (2): 201–8. PMID 12787521.
  2. ↑ 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.
  3. ↑ Gardam M, Lim S (December 2005). "Mycobacterial osteomyelitis and arthritis". Infect. Dis. Clin. North Am. 19 (4): 819–30. doi:10.1016/j.idc.2005.07.008. PMID 16297734.
  4. ↑ Cuéllar ML, Silveira LH, Espinoza LR (1992). "Fungal arthritis". Ann Rheum Dis. 51 (5): 690–7. PMC 1005712. PMID 1616344.
  5. ↑ Arvikar SL, Steere AC (2015). "Diagnosis and treatment of Lyme arthritis". Infect Dis Clin North Am. 29 (2): 269–80. doi:10.1016/j.idc.2015.02.004. PMC 4443866. PMID 25999223.
  6. ↑ Reginato A, Paul H, Schumacher HR (September 1982). "Crystal-induced arthritis". Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.
  7. ↑ 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.
  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.
  9. ↑ Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L; et al. (2014). "Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases". Medicine (Baltimore). 93 (1): 1–10. doi:10.1097/MD.0000000000000011. PMC 4616329. PMID 24378738.
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