Polyarthritis

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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 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

References

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