ACUTE MONOARTHRITIS BERGER

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ACUTE MONOARTHRITISBERGERS BS

• BUGS
• BLOOD
• BIREFRIGENCE

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CALCIUM PYROPHOSPHATE (cppd)

• Acute pseudogout
• Female predominant
• Knees/Shoulders/Wrists/MCPs
• High fever and sed rate possible
• Can coexist in same joint with true infectious
  etiology Unlike gout

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CALCIUM HYDROXYAPATITE

• Milwaukee Shoulder
• Shoulders/knees/hips
• Hemarthrosis associated
• Rotator cuff destruction
• Fever and high sed rate less common than in CPPD

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Musculoskeletal Presentations of Infectious
Diseases

• Known systemic infectious diseases with
  musculoskeletal presentations
• Probable infectious agent causing systemic
  rheumatic disease

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Post Streptococcal Arthritis(Rheumatic Fever)

• Shoulder periarthritis (80 in Persellin series
  in 1970s)
• Classical migratory large joint synovitis rare
• Nodules/Carditis/Athetosis rare
• E nodosum more common than E marginatum

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Gonorrhea

• Monoarticular/Pauciarticular synovitis Large
  joint predominance
• Recovery of organism from joint 10 or less.
  Smears negative
• When recovered from joint, Rx the same as Staph
  septic joint Recurrent aspirations

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KAWASAKI DISEASE

• Fever lasting at least 5 days
• Bilateral conjunctivitis
• Oral mucous membrane changes
• Peripheral extremity changes
• Polymorphus rash
• Cervical lymphadenopathy
• Lab markers of inflammation

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KAWASAKI DISEASE

• Inflammatory Arthritis 15-25
• Diarrhea/Abd pain 50
• Cough 35
• CORONARY ARTERITIS WITH ANEURYSMS ? 100 ACUTELY
• IVIG AND ASA!!!

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Parvovirus B19

• Rheumatoid Arthritis look alike Symmetrical
  Polyarthritis involving hands/wrists/knees/feet
• RF and ANA 20-30
• cryoglobulins
• 6 month course
• Steroids occasionally required

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HEPATITIS B

• Symmetrical polyarthritissmall joints
• Sometimes Urticarial rash
• Prodrome to jaundice
• Low serum complements
• Sometimes with glomerulonephritis

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RUBELLA

• Large joint oligoarthropathy almost always
  involving knees
• Can last months
• Chronic RA look alike described after initial
  infection
• Can occur after immunizations

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LYME DISEASE

• True arthritis tertiary manifestation
• Arthralgia common in secondary stage
• Pauciarticular large joint arthopathy
• Thought intially to be JRA
• One mother and local PTA YALE

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REACTIVE ARTHRITIS SYNDROME

• 90 with preceding chlamydial infection vs.
  bowel pathogen
• Also described after Chlamydia Pneumonia and
  Mycoplasma Pneumonia
• Chlamydial antigen demonstrated in synovium in
  involved joints
• ?? Controls
• ?? Immunological mechanism

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LOFGRENS SYNDROME

• Acute Histoplasmosis/Sarcoidosis
• Fever
• Erythema Nodosum
• Ankle Periarthritis
• Hilar Adenopathy
• Occasional uveitis/parotitis
• Usually resolves without sequelae

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GIANT CELL ARTERITIS

• Temporal /Takayasus arteritis
• Old Scandinavian women vs. young
  Japanese/Israeli/Mexican women
• Carotid vs. aortic arch circulation
• Systemic symptoms FUO presentation
• Symmetrical polyarthritis 10
• Sed rates!!!!!!!!
• Parvovirus anectdotes Mayo data

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BEHCETS SYNDROME

• Painful oral and genital ulcers
• Uveitis Anterior and posterior
• Pathergic skin rash
• Aseptic meningitis
• Hypercoaguability
• Pulmonary arterial aneurysms
• TNF excess Therapeutic options

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Relapsing Polychondritis

• True cause of ER Dx of costochondritis
• Chondritis/scleritis/vasculitis
• Fever and arthritis
• Palpable purpura
• Subglottic stenosis
• Tracheal collapse
• Rx with steroids and immunosuppresion

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