Polyarthritis with joint swelling and fever

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

			Symptoms				Physical examination			Lab Findings				Imaging			Histopathology
Diseases			Clinical manifestations							Para-clinical findings								Gold standard	Additional findings
			Symptoms				Physical examination			Para-clinical findings
			Joint Swelling	Fever	Weight loss	Claudication	Morning stiffness	Local erythema	Skin manifestation	CBC	ESR	Synovial fluid	Other	X-ray	CT scan	Other	Histopathology
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
	Infectious arthritis	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
	Postinfectious (reactive) arthritis	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	Inflammatory bowel disease^[5]	+	+	–	–	+	+/-	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
	Crystal-induced arthritis^[6]		+	+/-	–	–	–	+	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
Polyarticular pain	Viral arthritis	Parvovirus^[7]	+	+	+/-	–	–	–	Fifth disease/ Erythema infectiosum	Aplastic crisis	↑	Normal	ANA, RF, CRP	Joint swelling	–	–	Immune complex deposition	Parvovirus IgM antibody	Transient aplastic crisis, Fetal infection

References

↑ Lantos PM (2015). “Chronic Lyme disease”. Infect Dis Clin North Am. 29 (2): 325–40. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.
↑ 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.
↑ Kumar RK, Tandon R (2013). “Rheumatic fever & rheumatic heart disease: the last 50 years”. Indian J Med Res. 137 (4): 643–58. PMC 3724245. PMID 23703332.
↑ Colmegna I, Cuchacovich R, Espinoza LR (2004). “HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations”. Clin Microbiol Rev. 17 (2): 348–69. PMC 387405. PMID 15084505.
↑ Orchard TR (2012). “Management of arthritis in patients with inflammatory bowel disease”. Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
↑ Reginato A, Paul H, Schumacher HR (September 1982). “Crystal-induced arthritis”. Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.
↑ Moore TL (July 2000). “Parvovirus-associated arthritis”. Curr Opin Rheumatol. 12 (4): 289–94. PMID 10910181.

[pmid25999227-1] Lantos PM (2015). “Chronic Lyme disease”. Infect Dis Clin North Am. 29 (2): 325–40. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.

[pmid28630844-2] 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.

[pmid23703332-3] Kumar RK, Tandon R (2013). “Rheumatic fever & rheumatic heart disease: the last 50 years”. Indian J Med Res. 137 (4): 643–58. PMC 3724245. PMID 23703332.

[pmid15084505-4] Colmegna I, Cuchacovich R, Espinoza LR (2004). “HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations”. Clin Microbiol Rev. 17 (2): 348–69. PMC 387405. PMID 15084505.

[pmid22933865-5] Orchard TR (2012). “Management of arthritis in patients with inflammatory bowel disease”. Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.

[pmid62879632-6] Reginato A, Paul H, Schumacher HR (September 1982). “Crystal-induced arthritis”. Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.

[pmid10910181-7] Moore TL (July 2000). “Parvovirus-associated arthritis”. Curr Opin Rheumatol. 12 (4): 289–94. PMID 10910181.

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