Monoarthritis with claudication

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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 Neoplasms[1] + - + +/- - - Rash Normocytic normochromic anemia ↑  High WBC count (10,000-40,000/µL) Hypercalcemia, Hyperphosphatemia Peri-articular osteoblastic or osteoclastic lesion Elevation of the periosteum Intense radionuclide uptake in bone scan Spindle-shaped and atypical stromal cells, with irregular nuclei Clinical findings and imaging Nocturnal pain, Pathologic fractures
Infection Mycobacterial infection[2] - + + + +/- - 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
Lyme disease[3] + + +/- +/- - - 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
Systemic disorders Rheumatoid arthritis[4] + - + + + - Rheumatoid nodules Anemia, Thrombocytosis ↑ WBC count >2000/µL (generally 5000-50,000/µL), with neutrophilpredominance (60-80%) Anti-CCP Ab, Hyperuricemia Joint-space narrowing Microfractures Synovitis in MRI Influx of inflammatory cells into the synovial membrane, withangiogenesis Clinical findings coupled anti-CCP antibody Rheumatoid nodules
Myelodysplastic and leukemic disorders[5] + + + +/- - - 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. ↑ Askling J (October 2007). "Malignancy and rheumatoid arthritis". Curr Rheumatol Rep. 9 (5): 421–6. PMID 17915099.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
  5. ↑ 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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