Polyarthritis: Difference between revisions

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== Differential Diagnosis of Polyarthritis ==
== Differential Diagnosis of Polyarthritis ==
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
! colspan="3" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Diseases
! colspan="3" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Diseases
| colspan="5" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |'''Clinical manifestations'''
| colspan="7" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Para-clinical findings
! colspan="8" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Para-clinical findings
| colspan="1" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |'''Gold standard'''
| colspan="1" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |'''Gold standard'''
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Additional findings
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Additional findings
|-
|-
| colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |'''Symptoms'''
| colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |'''Symptoms'''
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Physical examination
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Physical examination
|-
|-
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Histopathology
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Histopathology
|-
|-
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! align="center" style="background:#4479BA; color: #FFFFFF;" |Claudication
! align="center" style="background:#4479BA; color: #FFFFFF;" |Claudication
! align="center" style="background:#4479BA; color: #FFFFFF;" |Biomarker
! align="center" style="background:#4479BA; color: #FFFFFF;" |Morning stiffness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Joint warmness and redness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Skin manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" |CBC
! align="center" style="background:#4479BA; color: #FFFFFF;" |CBC
! align="center" style="background:#4479BA; color: #FFFFFF;" |ESR
! align="center" style="background:#4479BA; color: #FFFFFF;" |ESR
! align="center" style="background:#4479BA; color: #FFFFFF;" |Synovial fluid
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" |X-ray
! align="center" style="background:#4479BA; color: #FFFFFF;" |CT scan
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
|-
|-
! rowspan="24" |Polyarthritis
! rowspan="23" style="background: #DCDCDC; padding: 5px; text-align: center;" |Polyarthritis
! rowspan="2" |Infectious arthritis
! rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Infectious arthritis]]
!Lyme disease
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lyme disease]]<ref name="pmid25999227">{{cite journal| author=Lantos PM| title=Chronic Lyme disease. | journal=Infect Dis Clin North Am | year= 2015 | volume= 29 | issue= 2 | pages= 325-40 | pmid=25999227 | doi=10.1016/j.idc.2015.02.006 | pmc=4477530 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25999227  }}</ref>
!+
! style="background: #F5F5F5; padding: 5px;" |+
!+
! style="background: #F5F5F5; padding: 5px;" |+
!+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
!+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
!Lyme encephalopathy, Acrodermatitis chronica atrophicans
! style="background: #F5F5F5; padding: 5px;" |-
![[CXCL9|CXCL9 (MIG)]], [[CXCL10|CXCL10 (IP-10)]] and [[CCL19|CCL19 (MIP3B)]]
! style="background: #F5F5F5; padding: 5px;" |-
![[Leukopenia]], [[Thrombocytopenia]]
! style="background: #F5F5F5; padding: 5px;" |[[Erythema migrans]]
!-
! style="background: #F5F5F5; padding: 5px;" |[[Leukopenia]], [[Thrombocytopenia]]
![[Microscopic hematuria]], [[Proteinuria]], ↑[[ALT]] or [[AST]]
! style="background: #F5F5F5; padding: 5px;" |-
!CT scan: Punctate lesions in periventricular [[white matter]] in [[brain]] [[SPECT]]
! style="background: #F5F5F5; padding: 5px;" |Cell counts 500-98,000/µL
![[Acrodermatitis chronica atrophicans]]
! style="background: #F5F5F5; padding: 5px;" |[[Microscopic hematuria]], [[Proteinuria]], ↑[[ALT]] or [[AST]]
![[Serological testing|Serologic '''tests''']]
! style="background: #F5F5F5; padding: 5px;" |-
![[Erythema migrans]]
! style="background: #F5F5F5; padding: 5px;" |-
|-
! style="background: #F5F5F5; padding: 5px;" |-
!Bacterial endocarditis
! style="background: #F5F5F5; padding: 5px;" |[[Fibrosis]] of the deeper [[dermis]] and hyalinization of collagen bundles
!+
! style="background: #F5F5F5; padding: 5px;" |[[Serological testing|Serologic '''tests''']]
!+
! style="background: #F5F5F5; padding: 5px;" |[[Erythema migrans]]
!+
!-
!Janeway lesions, Osler nodes, Roth spots
![[NT-proBNP]]
![[Normochromic anemia|Normochromic-normocytic anemia]]
!↑
![[Hypergammaglobulinemia|Hyperglobulinemia]], [[Cryoglobulinemia]]
!CT scan: [[Metastatic]] [[infections]], such as [[Splenic infarction|splenic infarct]], [[Renal infarct|renal infarcts]], or [[psoas abscess]]
 
Echo: [[Vegetation (pathology)|Vegetation]], [[abscess]], or new dehiscence of a [[Prosthetic valves|prosthetic valve]]<nowiki/>in [[echocardiography]]
![[Vegetation (pathology)|Vegetation]] or [[Abscess|intracardiac abscess]] demonstrating active [[endocarditis]]
![[Echocardiography]] ([[TTE]])
![[Janeway lesions]], [[Osler nodes]], [[Roth's spot|Roth spots]], [[Vertebral osteomyelitis]]
|-
|-
! rowspan="3" |'''Postinfectious (reactive) arthritis'''
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bacterial endocarditis]]<ref name="pmid28630844">{{cite journal| author=Soor P, Sharma N, Rao C| title=Multifocal Septic Arthritis Secondary to Infective Endocarditis: A Rare Case Report. | journal=J Orthop Case Rep | year= 2017 | volume= 7 | issue= 1 | pages= 65-68 | pmid=28630844 | doi=10.13107/jocr.2250-0685.692 | pmc=5458702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28630844  }}</ref>
 
! style="background: #F5F5F5; padding: 5px;" |+
!Rheumatic fever
! style="background: #F5F5F5; padding: 5px;" |+
!
! style="background: #F5F5F5; padding: 5px;" |+
!
! style="background: #F5F5F5; padding: 5px;" |-
!
! style="background: #F5F5F5; padding: 5px;" |-
!
! style="background: #F5F5F5; padding: 5px;" |+/-
!
! style="background: #F5F5F5; padding: 5px;" |[[Janeway lesions]], [[Osler nodes]], [[Roth spot|Roth spots]]
!
! style="background: #F5F5F5; padding: 5px;" |[[Normochromic anemia|Normochromic-normocytic anemia]]
!
! style="background: #F5F5F5; padding: 5px;" |↑
!
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]], [[Staphylococcus aureus|S. aureus]] in culture
!
! style="background: #F5F5F5; padding: 5px;" |[[Hypergammaglobulinemia|Hyperglobulinemia]], [[Cryoglobulinemia]]
!
! style="background: #F5F5F5; padding: 5px;" |Joint erosion and effusion
!
! style="background: #F5F5F5; padding: 5px;" |-
!
! style="background: #F5F5F5; padding: 5px;" |-
!
! style="background: #F5F5F5; padding: 5px;" |[[Vegetation (pathology)|Vegetation]] or [[Abscess|intracardiac abscess]] demonstrating active [[endocarditis]]
! style="background: #F5F5F5; padding: 5px;" |[[Echocardiography]] ([[TTE]])
! style="background: #F5F5F5; padding: 5px;" |[[Janeway lesions]], [[Osler nodes]], [[Roth's spot|Roth spots]], [[Vertebral osteomyelitis]]
|-
|-
!Reactive arthritis
! rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Reactive arthritis|Postinfectious (reactive) arthritis]]'''
!
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Rheumatic fever]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Enteric infection
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Reactive arthritis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! rowspan="3" |'''Other seronegative spondyloarthritides'''
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Enteric Bacilli|Enteric infection]]
 
! style="background: #F5F5F5; padding: 5px;" |
!Ankylosing spondylitis
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Psoriatic arthritis
! rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Other [[Seronegative spondyloarthritis|seronegative spondyloarthritides]]'''
!
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ankylosing spondylitis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Inflammatory bowel disease
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriatic arthritis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!'''Rheumatoid arthritis'''
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inflammatory bowel disease]]
!
! style="background: #F5F5F5; padding: 5px;" |
!+
! style="background: #F5F5F5; padding: 5px;" |
!-
! style="background: #F5F5F5; padding: 5px;" |
!+
! style="background: #F5F5F5; padding: 5px;" |
!+
! style="background: #F5F5F5; padding: 5px;" |
!Limited joint motion, Rheumatoid nodules
! style="background: #F5F5F5; padding: 5px;" |
!RF and anti-CCP antibodies
! style="background: #F5F5F5; padding: 5px;" |
!Anemia, Thrombocytosis
! style="background: #F5F5F5; padding: 5px;" |
!↑
! style="background: #F5F5F5; padding: 5px;" |
!Hyperuricemia, Arthrocentesis and synovial fluid analysis to exclude gout, Serologic studies
! style="background: #F5F5F5; padding: 5px;" |
!MRI and ultrasound: Synovitis
! style="background: #F5F5F5; padding: 5px;" |
CT scan: [[Fractures|Microfractures]]
! style="background: #F5F5F5; padding: 5px;" |
!Influx of [[inflammatory cells]] into the [[synovial membrane]], with  [[angiogenesis]], proliferation of chronic [[inflammatory cells]]
! style="background: #F5F5F5; padding: 5px;" |
!Clinical findings coupled [[Anti-citrullinated protein antibody|anti-CCP antibody]]
! style="background: #F5F5F5; padding: 5px;" |
![[Rheumatoid nodules]]
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!'''Inflammatory osteoarthritis'''
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Rheumatoid arthritis]]'''
!
! style="background: #F5F5F5; padding: 5px;" |+
!
! style="background: #F5F5F5; padding: 5px;" |-
!
! style="background: #F5F5F5; padding: 5px;" |+
!
! style="background: #F5F5F5; padding: 5px;" |+
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |Rheumatoid nodules
!
! style="background: #F5F5F5; padding: 5px;" |Anemia, Thrombocytosis
!
! style="background: #F5F5F5; padding: 5px;" |↑
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |Hyperuricemia, Arthrocentesis and synovial fluid analysis to exclude gout, Serologic studies
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |CT scan: [[Fractures|Microfractures]]
!
! style="background: #F5F5F5; padding: 5px;" |MRI and ultrasound: Synovitis
! style="background: #F5F5F5; padding: 5px;" |Influx of [[inflammatory cells]] into the [[synovial membrane]], with  [[angiogenesis]], proliferation of chronic [[inflammatory cells]]
! style="background: #F5F5F5; padding: 5px;" |Clinical findings coupled [[Anti-citrullinated protein antibody|anti-CCP antibody]]
! style="background: #F5F5F5; padding: 5px;" |[[Rheumatoid nodules]]
|-
|-
!'''Crystal-induced arthritis'''
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Osteoarthritis|Inflammatory osteoarthritis]]'''
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! rowspan="8" |'''Systemic rheumatic illnesses'''
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Crystal arthritis|Crystal-induced arthritis]]'''
!Systemic lupus erythematosus
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Systemic vasculitis
! rowspan="7" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Systemic [[Rheumatic disease|rheumatic illnesses]]'''
!
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Systemic lupus erythematosus]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Systemic sclerosis
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Systemic vasculitis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Polymyositis/dermatomyositis
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Systemic sclerosis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Still's disease
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polymyositis]]/[[dermatomyositis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Behçet's syndrome
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Still's disease]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Relapsing polychondritis
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Behçet's disease|Behçet's syndrome]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Autoinflammatory disorders
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Relapsing polychondritis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! rowspan="5" |'''Other systemic illnesses'''
! rowspan="5" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Other systemic illnesses'''
!Sarcoidosis
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Palindromic rheumatism
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Palindromic rheumatism]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Familial Mediterranean fever
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Familial mediterranean fever|Familial Mediterranean fever]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Malignancy
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malignancy]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
!Hyperlipoproteinemias
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyperlipoproteinemia|Hyperlipoproteinemias]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! rowspan="9" |Polyarticular pain
! rowspan="9" style="background: #DCDCDC; padding: 5px; text-align: center;" |Polyarticular pain
! rowspan="3" |Viral arthritis
! rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Viral arthritis
|'''Hepatitis B and C'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hepatitis B]] and [[Hepatitis C|C]]'''
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
|'''Rubella'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Rubella]]'''
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
|'''Parvovirus'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Parvovirus]]'''
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! colspan="2" |Fibromyalgia
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fibromyalgia]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! colspan="2" |Soft tissue abnormalities
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Soft tissue abnormalities
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! colspan="2" |Hypothyroidism
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypothyroidism]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! colspan="2" |Neuropathic pain
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neuropathic pain]]
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
! style="background: #F5F5F5; padding: 5px;" |
|-
|-
! colspan="2" |Metabolic bone disease
! colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic bone disease
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
! style="background: #F5F5F5; padding: 5px;" |
!
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Revision as of 18:14, 19 April 2018

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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

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 Joint warmness and redness Skin manifestation CBC ESR Synovial fluid Other X-ray CT scan Other
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
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
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

  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.
  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.

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