Approach to the patient with polyarthritis

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Approach to the patient with polyarthritis
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(No Transcript)
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Polyarthralgia common causes

• RA
• Erosive OA
• Crystal arthritis
• Systemic rheumatic illness
• SLE, Stills, Behcets, systemic
• vasculitis, relapsing polychondritis
• Seronegative SpA

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Polyarthralgia common causes

• Postinfective/reactive
• Rheumatic fever,Reiter syndrome
• Infections
• Bacterial Lyme, bacterial endocarditis
• Viral hepatitis, rubella, parvo
• Sarcoid
• Hyperlipoproteinaemia

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Polyarthralgia common causes

• Malignancies
• Fibromyalgia/MFPS
• Multiple bursitis/tendinitis
• Hypothyroidism
• Neuropathy
• Metabolic bone disease
• Depression

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History Joint symptoms

• Pain site, quality, onset, relieving factors,
  exacerbating factors
• Swelling
• Inflammatory vs noninflammatory characteristics
• Other joint involvement Mono/polyarthritis,
  Symmetry, Migratory/additive, small/large joints

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History Other factors

• Multisystem involvement eys, skin, other organ
  systems esp GI/GU symptoms
• Travel history
• Immune status

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Examination

• Fever
• Infection bacterial, viral
• Reactive arthritis
• RA/Stills
• Connective tissue diseases eg SLE
• Crystal arthritis
• Cancer
• Sarcoidosis

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Examination

• Skin
• Nodules RA, gout tophi
• Rash psoriasis, lupus, Stills, viral etc
• Inability to bear weight
• Sepsis
• Fracture
• Crystal arthritis
• Neurologic

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Examination

• Signs of inflammation
• Synovitis (soft tissue swelling)
• Local heat
• Effusion
• Range of motion
• ? Active, N Passive soft tissue eg bursitis,
  tendinitis, muscle
• ? Active, ? Passive contracture, synovitis,
  structural abnormality

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Imaging

• X-ray
• Fracture
• Tumour
• Arthritis chondrocalcinosis, gout, RA, OA
• Ultrasound
• Effusion, guide needle for aspiration
• CT/MRI
• Tumour, guide needle for aspiration,
  osteonecrosis
• Bone scan
• Infection, stress , osteonecrosis

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Synovial fluid aspiration

• Visual appearance
• Xanthochromia recent bleed (trauma, coagulation)
• Clear/cloudy
• White cell count, differential
• Gram stain culture
• Polarising microscopy for crystals

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Systemic rheumatic disease

• Spondylarthropathy
• Rheumatoid arthritis
• Systemic lupus erythematosis
• Sarcoidosis
• Etc.

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Migrating arthritiscauses

• Rheumatic fever
• Gonococcal infection
• Meningococcal infection
• Viral arthritis
• SLE
• Acute leukemia