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Approach to the patient with polyarthritis

Approach to the patient with polyarthritis. Polyarthralgia: common causes. RA Erosive OA Crystal arthritis Systemic rheumatic illness: SLE, Still’s, Behcet’s, systemic vasculitis, relapsing polychondritis Seronegative SpA. Polyarthralgia: common causes. Postinfective/reactive :

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Approach to the patient with polyarthritis

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  1. Approach to the patient with polyarthritis

  2. Polyarthralgia: common causes • RA • Erosive OA • Crystal arthritis • Systemic rheumatic illness: SLE, Still’s, Behcet’s, systemic vasculitis, relapsing polychondritis • Seronegative SpA

  3. Polyarthralgia: common causes • Postinfective/reactive: • Rheumatic fever,Reiter syndrome • Infections • Bacterial: Lyme, bacterial endocarditis • Viral: hepatitis, rubella, parvo • Sarcoid • Hyperlipoproteinaemia

  4. Polyarthralgia: common causes • Malignancies • Fibromyalgia/MFPS • Multiple bursitis/tendinitis • Hypothyroidism • Neuropathy • Metabolic bone disease • Depression

  5. 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

  6. History: Other factors • Multisystem involvement: eys, skin, other organ systems esp GI/GU symptoms • Travel history • Immune status

  7. Examination • Fever • Infection: bacterial, viral • Reactive arthritis • RA/Still’s • Connective tissue diseases eg SLE • Crystal arthritis • Cancer • Sarcoidosis

  8. Examination • Skin • Nodules: RA, gout tophi • Rash: psoriasis, lupus, Still’s, viral etc • Inability to bear weight • Sepsis • Fracture • Crystal arthritis • Neurologic

  9. 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

  10. 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

  11. Synovial fluid aspiration • Visual appearance • Xanthochromia: recent bleed (trauma, coagulation) • Clear/cloudy • White cell count, differential • Gram stain + culture • Polarising microscopy for crystals

  12. Systemic rheumatic disease • Spondylarthropathy • Rheumatoid arthritis • Systemic lupus erythematosis • Sarcoidosis • Etc….

  13. Migrating arthritis:causes • Rheumatic fever • Gonococcal infection • Meningococcal infection • Viral arthritis • SLE • Acute leukemia

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