Polyarthritis with joint swelling

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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
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) Vertebral osteomyelitis
Postinfectious (reactive) arthritis Rheumatic fever[3] + + - - - +/- Erythema marginatum rheumaticum Leukocytosis Sterile inflammatory reaction with cells<20,000/μL Streptococcal antibody titer Cardiomegaly Valvular or pericardial calcification Echocardiographic changes in heart valves Edema, Fibrinoid necrosis, Mononuclear cell infiltrate Echocardiography Chorea, Carditis 
Reactive arthritis[4] +/- +/- - - - - 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
Other seronegative spondyloarthritides Ankylosing spondylitis[5] + - +/- +/- + - 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 
Psoriatic arthritis[6] + - - - - + Scaly erythematous plaques,

Guttate lesions, Lakes of pus,

Erythroderma

Normal High WBC count (5000-15,000/µL) with >50% of PMN leukocytes RF, ANA, IgA Joint-space narrowing, Fluffy periostitis Pencil-in-cup deformity, Early signs of synovitis Sacroiliitic synovitis, Enthesitis in MRI Lack of intrasynovial Ig and RF, Greater propensity for fibrous ankylosis, osseous resorption, and heterotopic bone formation Clinical findings Onycholysis, Splinter hemorrhages
Inflammatory bowel disease[7] + + - - + +/- 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[8] + - + + + - 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
Crystal-induced arthritis[9] + +/- - - - + Joint erythema Leukocytosis Needle shaped urate crystals, WBC count > 2000/µL Urinary uric acid (>1100 mg in 24h) Punched-out erosions or lytic areas 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 assay Conjunctival nodules
Systemic rheumatic illnesses Systemic lupus erythematosus[10] + - +/- - - + Malar rash, Photosensitivity, Discoid lupus Leukopenia, Lymphopenia, Anemia, Thrombocytopenia Cell count from < 25% PMNs (non-inflammatory effusions) to > 50% PMNs (inflammatory effusions) Creatine kinase, LFT, ANA, Anti-dsDNA, Anti-Sm, Lupus anticoagulant Periarticular osteopenia and soft-tissue swelling without erosions Interstitial lung disease, Pneumonitis, Pulmonary emboli, Alveolar hemorrhage Pericardial effusion, Pulmonary hypertension, Verrucous Libman-Sacks endocarditis in echocardiography Inflammatory infiltrates at the dermoepidermal junction and vacuolar change in the basal columnar cells Anti-dsDNA Rheumatoid arthritis, Serositis, Oral ulcers
Behçet's syndrome[11] + - - - - - Erythema nodosum Normocytic normochromic anemia Cell count < 25% PMNs (non-inflammatory) Serum complement levels, Human leukocyte antigen (HLA)-B51 Soft tissue swelling Non-erosive synovitis - Dermal vessels infiltration with lymphocytes and plasma cells, Immune deposits of immunoglobulin M (IgM) and C3 Clinical findings Oral ulcer, Mucosal erosion
Relapsing polychondritis[12] + - - - - - - LeukocytosisAnemia - Cell count < 25% PMNs (non-inflammatory) CryoglobulinsANAC-ANCA Tracheal stenosis in CXR Calcification of cartilaginous structures Aortic root dilatation and degree of aortic regurgitation in echocardiography Chondrolysis, Chondritis, Perichondritis Clinical findings coupled with imaging Ear pain and redness, Polyarthritis
Other systemic illnesses Sarcoidosis[13] + - - - - - Mild papules and nodules Mild anemia Cell count < 25% PMNs (non-inflammatory)  IL-2 and IFN-γ, ↑ACE, ↑1, 25-dihydroxyvitamin D Bilateral hilar adenopathy Active alveolitis or fibrosis Hepatosplenomegaly in ultrasonography Noncaseating granulomas (NCGs) Histological confirmation Heart blockOcular lesion
Palindromic rheumatism[14] + - - +/- + - Rheumatoid nodules Anemia High WBC count (5000-15,000/µL) with >50% of PMN leukocytes RFAnti-CCP antibody, ↑Cr or BUN,

ALT or ASTANA

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 Viral arthritis Parvovirus[15] + + +/- - - - Fifth disease/ Erythema infectiosum Aplastic crisis Normal ANA, RF, CRP Joint swelling - - Immune complex deposition Parvovirus IgM antibody Transient aplastic crisis, Fetal infection
Soft tissue abnormalities + - - - - +/- Maculopapular rash Normal - Cell count < 25% PMNs (non-inflammatory) CRP, Ca Joint swelling Synovial edema and thickness Mild joint effusion in ultrasonography Mild inflammation Clinical findings Mucositis, Enthesitis

References

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  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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  5. McVeigh CM, Cairns AP (2006). "Diagnosis and management of ankylosing spondylitis". BMJ. 333 (7568): 581–5. doi:10.1136/bmj.38954.689583.DE. PMC 1570004. PMID 16974012.
  6. Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J (2013). "Psoriatic arthritis". Pol J Radiol. 78 (1): 7–17. doi:10.12659/PJR.883763. PMC 3596149. PMID 23493653.
  7. Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
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  9. Reginato A, Paul H, Schumacher HR (September 1982). "Crystal-induced arthritis". Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.
  10. Manson JJ, Rahman A (2006). "Systemic lupus erythematosus". Orphanet J Rare Dis. 1: 6. doi:10.1186/1750-1172-1-6. PMC 1459118. PMID 16722594.
  11. Sugawara S, Ehara S, Hitachi S, Sugimoto H (March 2010). "Hand and wrist arthritis of Behçet disease: imaging features". Acta Radiol. 51 (2): 183–6. doi:10.3109/02841850903401349. PMID 20121672.
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  13. Iannuzzi MC, Rybicki BA, Teirstein AS (November 2007). "Sarcoidosis". N. Engl. J. Med. 357 (21): 2153–65. doi:10.1056/NEJMra071714. PMID 18032765.
  14. Iyer VR, Cohen GL (February 2011). "Palindromic rheumatism". South. Med. J. 104 (2): 147–9. doi:10.1097/SMJ.0b013e318200c4cc. PMID 21206416.
  15. Moore TL (July 2000). "Parvovirus-associated arthritis". Curr Opin Rheumatol. 12 (4): 289–94. PMID 10910181.