Overview
Once arthritis is suspected, physicians should distinguish between noninflammatory and inflammatory forms of arthritis while recognizing potentially disabling and life-threatening problems.
Rule out septic arthritis in any monoarthritic presentation, prolonged diagnosis results in irreversible joint damage.
Definition
Polyarthralgia: multiple joint pain without synovities.
Polyarthritis: inflammation of 4 or more joints (synovitis).
| Monoarthropathy | Oligoarthropathy | Polyarthropathy |
| Septic arthritis | Crystal arthritis | Rheumatoid arthritis |
| Crystal arthritis (Gout) | Psoriatic arthritis | Viral Arthritis |
| Osteoarthritis (can be mono-poly) | Reactive arthritis | Autoimmune connective tissue disease (ie. SLE) |
| Trauma (Haemarthrosis) | Ankylosing spondylititis | Vasculitides (ie. Polymyalgia Rheumatica) |
Approach
- History
- Sex
- Age of onset
- Pattern of arthritis
- Extra-articular features
- Which joints affected
- peripheral symmetrical arthritis – Rheumatoid arthritis
- Asymmetric with enthesitis and back pain – spondylarthritis
- DIP joints with synovitis – psoriatic arthritis
| Age | |
| Child | Trauma, Congenital, slipped capital femoral epihpysis, Juvenile rheumatoid arthritis |
| Young Adults | Reactive arthritis, gonococcal, SLE |
| Older patients | Acute gout and Pseudogout, Rheumatoid arthrits |
- Examination
- Psoraiasis
- Malar rash – SLE
- Kerataderma blenorrhagica – Septic arthritis
- Salmon
- Investigations
Differential Diagnosis
Arthritis can be divided into:
- Acute or chronic
- Monoarthritis, Oligoarthritis, Polyarthritis
- Inflammatory and non-inflammatory
- Seropositive or seronegative
Non-inflammatory Arthritis
Inflammatory Arthritis
- Crystal arthropathy
- Infectious
- Seronegative arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
- IBD arthritis
- Seropositive arthritis
- Rheumatoid Arthritis
- Scleroderma
- Vasculitis
- Sjogren’s