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Polyarthritis with weight loss


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

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Joint Swelling Fever Weight loss Claudication Morning stiffness Local erythema Skin manifestation CBC ESR Synovial fluid Other X-ray CT scan Other
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
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
Other seronegative spondyloarthritides Ankylosing spondylitis[3] + – +/- +/- + – Dactylitis (sausage digit) Normocytic normochromic anemia ↑  High WBC count (lymphocyte predominance) ↑Alkaline phosphatase (ALP) Bony erosions and sclerosis of the joints  Early sacroiliitis, erosions, and enthesitis Possible cauda equina syndrome secondary to spinal stenosis in MRI Chronic inflammation with CD4+ and CD8+ T lymphocytes and macrophages Plain x-rays Peripheral enthesitis, Uveitis 
Rheumatoid arthritis[4] + – + + + – Rheumatoid nodules Anemia, Thrombocytosis ↑ WBC count >2000/µL (generally 5000-50,000/µL), with neutrophil predominance (60-80%) Anti-CCP Ab, Hyperuricemia Joint-space narrowing Microfractures Synovitis in MRI Influx of inflammatory cells into the synovial membrane, with angiogenesis Clinical findings coupled anti-CCP antibody Rheumatoid nodules
Systemic rheumatic illnesses Systemic lupus erythematosus[5] + – +/- – – + Malar rash, Photosensitivity, Discoid lupus Leukopenia, Lymphopenia, Anemia, Thrombocytopenia ↑ Cell count from < 25% PMNs (non-inflammatory effusions) to > 50% PMNs (inflammatory effusions) Creatine kinase, LFT, ANA, Anti-dsDNA, Anti-Sm, Lupus anticoagulant Periarticular osteopenia and soft-tissue swelling without erosions Interstitial lung disease, Pneumonitis, Pulmonary emboli, Alveolar hemorrhage Pericardial effusion, Pulmonary hypertension, Verrucous Libman-Sacks endocarditis in echocardiography Inflammatory infiltrates at the dermoepidermal junction and vacuolar change in the basal columnar cells Anti-dsDNA Rheumatoid arthritis, Serositis, Oral ulcers
Systemic vasculitis[6] – – +/- + – – Petechia, Purpura Anemia, Thrombocytosis ↑ – P-ANCA, C-ANCA, ANA Soft tissue swelling with mild erosions Focal regions of infarction or hemorrhage Multiple microaneurysms,Hemorrhage due to focal rupture, Occlusion in angiography Acute destruction of the media by neutrophils, with loss of elastic fibers Angiography Peripheral neuropathy, Livedo reticularis
Systemic sclerosis[7] – – +/- – – – 3 phases of (1) Edematous, (2) Indurative, and (3) Atrophic Thrombocytopenia ↑ Cell count < 25% PMNs (non-inflammatory) Hypergammaglobulinemia,

Creatine phosphokinase

Juxta-articular osteoporosis, Joint space narrowing, Frank erosions Synovial inflammation Synovial vascularity in doppler ultrasonography Epidermal skin appendages atrophy, Broad and hyalinized collagen fibers in the reticular dermis Histopathology Raynaud phenomenon, Tendon friction rubs
Polymyositis/dermatomyositis[8] – – +/- – – + Heliotrope rash, Gottron papules, Poikiloderma Normocytic normochromic anemia ↑ Predominantly mononuclear cells and large macrophage-like cells Anti–Mi-2 antibodies, Anti–Jo-1 antibodies, Creatine kinase, ANA Marginal erosions and periarticular calcification – – Vacuolar changes of the columnar epithelium and lymphocytic infiltrates Muscle biopsy Dysphagia 
Still’s disease[9] – – +/- – +/- + Mild papules and nodules Anemia, Thrombocytosis ↑ High WBC count (5000-15,000/µL) with >50% of PMN leukocytes ANA, RF Soft tissue swelling,

Osteopenia,

Joint-space narrowing

Synovial inflammation Inflamed synovium in ultrasonography Inflammatory infiltration in synovium Clinical findings and synovial fluid analysis Ocular involvement
Polyarticular pain Viral arthritis Hepatitis B and C[10] – + + – – – Urticarial and maculopapular eruptions  Leukocytosis ↑ Cell counts < 100,000/µL LFT, HBsAg Joint space narrowing – – Deposition of immune complexes, Cryoprecipitates containing HBsAg and complements HBsAg Liver failure, Icterus
Rubella[11] – + +/- – – – Acute maculopapular rash Leukocytosis ↑ Rubella virus antigen LFT, CRP Joint space narrowing – – proliferation of the synovial lining cells, without inflammatory

cells

Serological evidence Headache, Malaise
Parvovirus[12] + + +/- – – – Fifth disease/ Erythema infectiosum Aplastic crisis ↑ Normal ANA, RF, CRP Joint swelling – – Immune complex deposition Parvovirus IgM antibody Transient aplastic crisis, Fetal infection
Depression[13] – – + – – – – Normal – Normal Normal – – – – Psychological interview Slow psychomotor, Muscle pain

References

  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.
  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.
  3. ↑ McVeigh CM, Cairns AP (2006). “Diagnosis and management of ankylosing spondylitis”. BMJ. 333 (7568): 581–5. doi:10.1136/bmj.38954.689583.DE. PMC 1570004. PMID 16974012.
  4. ↑ Heidari B (2011). “Rheumatoid Arthritis: Early diagnosis and treatment outcomes”. Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
  5. ↑ Manson JJ, Rahman A (2006). “Systemic lupus erythematosus”. Orphanet J Rare Dis. 1: 6. doi:10.1186/1750-1172-1-6. PMC 1459118. PMID 16722594.
  6. ↑ Watts RA, Scott DG (October 2016). “Vasculitis and inflammatory arthritis”. Best Pract Res Clin Rheumatol. 30 (5): 916–931. doi:10.1016/j.berh.2016.10.008. PMID 27964796.
  7. ↑ Avouac, J.; Clements, P. J.; Khanna, D.; Furst, D. E.; Allanore, Y. (2012). “Articular involvement in systemic sclerosis”. Rheumatology. 51 (8): 1347–1356. doi:10.1093/rheumatology/kes041. ISSN 1462-0324.
  8. ↑ Briemberg HR, Amato AA (September 2003). “Dermatomyositis and Polymyositis”. Curr Treat Options Neurol. 5 (5): 349–356. PMID 12895397.
  9. ↑ Kadavath S, Efthimiou P (February 2015). “Adult-onset Still’s disease-pathogenesis, clinical manifestations, and new treatment options”. Ann. Med. 47 (1): 6–14. doi:10.3109/07853890.2014.971052. PMID 25613167.
  10. ↑ Ganem, Don; Prince, Alfred M. (2004). “Hepatitis B Virus Infection — Natural History and Clinical Consequences”. New England Journal of Medicine. 350 (11): 1118–1129. doi:10.1056/NEJMra031087. ISSN 0028-4793.
  11. ↑ Spruance SL, Metcalf R, Smith CB, Griffiths MM, Ward JR (March 1977). “Chronic arthropathy associated with rubella vaccination”. Arthritis Rheum. 20 (2): 741–7. PMID 849368.
  12. ↑ Moore TL (July 2000). “Parvovirus-associated arthritis”. Curr Opin Rheumatol. 12 (4): 289–94. PMID 10910181.
  13. ↑ Trivedi MH (2004). “The link between depression and physical symptoms”. Prim Care Companion J Clin Psychiatry. 6 (Suppl 1): 12–6. PMC 486942. PMID 16001092.

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