Polyarticular Arthritis - Temple Family Medicine Review

Polyarticular Arthritis

Irene J. Tan, MD, FACR

Einstein Medical Center Philadelphia Chair, Division of Rheumatology Family Medicine Board Review Lecture ? 10/7/2020 Crowne Plaza, Cherry Hill, NJ Virtually

Disclosures

? I have no relevant conflicts of interest

Learning Objectives

? Illustrate the approach to patients with polyarticular pain ? Differentiate clinical signs in patients with joint pain ? Recognize common causes of polyarticular joint pain

Polyarticular Pain

? Common in clinical practice ? Causes: self-limited illness to life-threatening disorders ? Source of the pain may be intraarticular or extraarticular, including

periarticular (tendon, ligament), neuropathic, marrow/vascular, dermal ? Most useful information is complete history and physical exam ? Confirm or refute diagnosis with blood and radiographic tests if necessary

What to look for in Polyarticular Joint pain

Findings Fever and malaise Malaise and lymphadenopathy

Bone tenderness or chest pain Coexisting tendinitis Oral and genital ulcer Raised silver plaques Recent pharyngitis and migrating joint pain Recent vaccination or blood product Tick bites Skin ulcerations, rash and abdominal pain Urethritis

Possible Cause Infection, gout, rheumatic disorders, vasculitis Acute infection: HIV, viral, malignancy, rheumatic disorders Sickle cell crisis Gonococcal or rheumatoid arthritis Behcet's syndrome Psoriatic arthritis Rheumatic fever

Serum sickness

Lyme arthritis Vasculitis

Gonococcal or reactive arthritis

Musculoskeletal Emergencies

? Red, hot, swollen joint ? septic arthritis ? Constitutional symptoms (fever, weight loss, malaise) ? infection or

sepsis ? Burning, numbness, paresthesia ? acute myelopathy, radiculopathy,

neuropathy ? Joint pain out of proportion from finding ? compartment syndrome

Laboratory Studies

? CBC, CMP ? ESR, CRP ? TSH, 25-OH vitamin D ? Serum uric acid ? Antibodies : hepatitis B & C, Parvovirus, Borrelia ? Autoantibodies: ANA, RF, anti-CCP ? Synovial fluid analysis (cell count, crystal identification, +/- culture)

Imaging Studies

? X-ray of affected joint: differentiate OA, RA, CPPD, chronic gout ? Additional imaging if lymphadenopathy is encountered, sarcoid,

other systemic disorders or malignancy is suspected

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