Monoarthritis with joint swelling

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

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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
Monoarthritis  | Osteoarthritis[1] | \+  | \-  | \-  | \-  | \-  | \-  | Heberden nodes | Anemia | \-  | Noninflammatory joint fluid  | Urinary pyridinium cross-links  | Joint-space loss, Subchondral bony sclerosis, Cyst formation  | Malalignment of the patellofemoral joint | Early diagnosis of osteoarthritis of the hand with bone scan | \-  | Clinical findings  | Microfracture, Bone pain
Trauma[2] | \+  | \-  | \-  | \-  | \-  | \+  | Wound or laceration | \-  | \-  | Hemarthrosis | \-  | Severe joint effusion, Fracture | Fracture, Synovial tear  | \-  | \-  | X-ray | Deformity, Severe pain
Neoplasms[3] | \+  | \-  | \+  | +/-  | \-  | \-  | Rash | Normocytic normochromic anemia | ↑  |  High WBC count (10,000-40,000/µL)  | Hypercalcemia, Hyperphosphatemia | Peri-articular osteoblastic or osteoclastic lesion  | Elevation of the periosteum | Intense radionuclide uptake in bone scan | Spindle-shaped and atypical stromal cells, with irregular nuclei | Clinical findings and imaging  | Nocturnal pain, Pathologic fractures
Infection | Gonococcal infection[4] | \+  | \+  | \-  | \-  | \-  | \+  | Maculopapular, Pustular, Vesicular lesions on an erythematous base | Leukocytosis | ↑  | Purulent with cell count > 50,000 WBC/µL (with PMNs > 90%)  | Blood and synovial fluid culture | Minor articular damage  | \-  | \-  | Dermal vasculitis with perivascular neutrophils | Nucleic acid amplification tests (NAATs) | Dermatitis, Tenosynovitis
Nongonococcal bacterial infections[5] | \+  | \+  | \-  | \-  | \-  | \+  | Local erythema | Leukocytosis | ↑  | Purulent with cell count > 50,000 WBC/µL (with PMNs > 90%)  | Blood and synovial fluid culture | Joint effusion, Cartilage destruction, Joint space narrowing  | Sternoclavicular or sacroiliac joint infections  | Periarticular osteomyelitis in MRI | \-  | Synovial fluid culture  | Limping, Malaise
Lyme disease[6] | \+  | \+  | +/-  | +/-  | \-  | \-  | Erythema migrans | Leukopenia, Thrombocytopenia | \-  | Cell counts 500-98,000/µL  | Microscopic hematuria, Proteinuria, ↑ALT or AST | Knee joint effusion. Intra-articular edema | \-  | Unspecific effusion, Synovial thickening or enhancement in MRI | Fibrosis of the deeper dermis and hyalinization of collagen bundles  | Serologic tests | Erythema migrans
Crystal-induced arthritis | Gout[7] | \+  | +/-  | \-  | \-  | \-  | \+  | Local swelling and erythema | Leukocytosis | ↑  | Needle shaped urate crystals, WBC count > 2000/µL  | Urinary uric acid (>1100 mg in 24h)  | Punched-out erosions or lyticareas 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 microscopy  | Conjunctival nodules
Pseudo-gout[8] | \+  | \-  | \-  | \-  | \-  | +/-  | Local swelling and erythema | Leukocytosis | ↑  | Rod shaped CPPD crystals, WBC count > 2000/µL  | Hypercalcemia, Hypercalciuria | Radiodense lines paralleling the articular surface and calcification (chondrocalcinosis)  | Calcific mass with a lobulated configuration in the ligamentum flavum or the joint capsule | Synovitis and calcific deposits in ultrasonography | Synovial calcium pyrophosphate crystals | Synovial fluid microscopy  | Tenderness
Systemic disorders | Reactive arthritis[9] | +/-  | +/-  | \-  | \-  | \-  | \-  | 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
Psoriatic arthritis[10] | \+  | \-  | \-  | \-  | \-  | \+  | Scaly erythematous plaques,

Guttate lesions, Lakes of pus,

Erythroderma

| Normal  | ↑  | High WBC count (5000-15,000/µL) with >50% of PMN leukocytes | ↑RF, ANA, IgA | Joint-space narrowing, Fluffy periostitis | Pencil-in-cup deformity, Early signs of synovitis | Sacroiliitic synovitis, Enthesitis in MRI | Lack of intrasynovial Ig and RF, Greater propensity for fibrous ankylosis, osseous resorption, and heterotopic bone formation | Clinical findings  | Onycholysis, Splinter hemorrhages
Inflammatory bowel disease-associated arthritis[11] | \+  | \+  | \-  | \-  | \+  | +/-  | Pyoderma gangrenosum(ulcerative colitis),Erythema nodosum(Crohn disease)  | Iron deficiency anemia, Leukocytosis, Thrombocytosis | ↑  | Mild to moderate inflammatory fluid, PMNpredominance  | ↑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
Sarcoid periarthritis[12] | \+  | \-  | \-  | \-  | \-  | \-  | Mild papules and nodules | Mild anemia | ↑  | Cell count < 25% PMNs (non-inflammatory)  |  IL-2 and IFN-γ, ↑ACE, ↑1, 25-dihydroxyvitamin D | Bilateral hilar adenopathy | Active alveolitis or fibrosis | Hepatosplenomegaly in ultrasonography | Noncaseating granulomas (NCGs) | Histological confirmation | Heart block, Ocular lesion
Rheumatoid arthritis[13] | \+  | \-  | \+  | \+  | \+  | \-  | Rheumatoid nodules | Anemia, Thrombocytosis | ↑  | WBC count >2000/µL (generally 5000-50,000/µL), with neutrophilpredominance (60-80%)  | Anti-CCP Ab, Hyperuricemia | Joint-space narrowing  | Microfractures | Synovitis in MRI | Influx of inflammatory cells into the synovial membrane, withangiogenesis | Clinical findings coupled anti-CCP antibody | Rheumatoid nodules
Myelodysplastic and leukemic disorders[14] | \+  | \+  | \+  | +/-  | \-  | \-  | Petechia and purpura | Anemia,

Leukocytosis,

Thrombocytopenia

| ↑  | WBC count >2000/µL (inflammatory), with neutrophilpredominance  | LDH, Uric acid | Articular surface erosion, Synovial effusion  | Thickened synovium | Synovitis in MRI | Inflammatory cells infiltration in synovial tissue  | Bone marrow biopsy | Fatigue, Nausea, Recurrent infections

## References

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1. ↑ Chen D, Shen J, Zhao W, Wang T, Han L, Hamilton JL; et al. (2017). "Osteoarthritis: toward a comprehensive understanding of pathological mechanism". Bone Res. 5: 16044. doi:10.1038/boneres.2016.44. PMC 5240031. PMID 28149655.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
2. ↑ Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F; et al. (2016). "Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation". RMD Open. 2 (2): e000279. doi:10.1136/rmdopen-2016-000279. PMC 5013366. PMID 27651925.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
3. ↑ Askling J (October 2007). "Malignancy and rheumatoid arthritis". Curr Rheumatol Rep. 9 (5): 421–6. PMID 17915099.
4. ↑ Bardin T (April 2003). "Gonococcal arthritis". Best Pract Res Clin Rheumatol. 17 (2): 201–8. PMID 12787521.
5. ↑ García-De La Torre I, Nava-Zavala A (February 2009). "Gonococcal and nongonococcal arthritis". Rheum. Dis. Clin. North Am. 35 (1): 63–73. doi:10.1016/j.rdc.2009.03.001. PMID 19480997.
6. ↑ Arvikar SL, Steere AC (2015). "Diagnosis and treatment of Lyme arthritis". Infect Dis Clin North Am. 29 (2): 269–80. doi:10.1016/j.idc.2015.02.004. PMC 4443866. PMID 25999223.
7. ↑ Reginato A, Paul H, Schumacher HR (September 1982). "Crystal-induced arthritis". Arch Phys Med Rehabil. 63 (9): 401–8. PMID 6287963.
8. ↑ Macmullan P, McCarthy G (2012). "Treatment and management of pseudogout: insights for the clinician". Ther Adv Musculoskelet Dis. 4 (2): 121–31. doi:10.1177/1759720X11432559. PMC 3383522. PMID 22870500.
9. ↑ 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.CS1 maint: Multiple names: authors list (link)
10. ↑ Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J (2013). "Psoriatic arthritis". Pol J Radiol. 78 (1): 7–17. doi:10.12659/PJR.883763. PMC 3596149. PMID 23493653.CS1 maint: Multiple names: authors list (link)
11. ↑ Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
12. ↑ Iannuzzi MC, Rybicki BA, Teirstein AS (November 2007). "Sarcoidosis". N. Engl. J. Med. 357 (21): 2153–65. doi:10.1056/NEJMra071714. PMID 18032765.
13. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
14. ↑ Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L; et al. (2014). "Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases". Medicine (Baltimore). 93 (1): 1–10. doi:10.1097/MD.0000000000000011. PMC 4616329. PMID 24378738.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)