Monoarthritis 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

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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  | Neoplasms[1] | \+  | \-  | \+  | +/-  | \-  | \-  | 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 | Mycobacterial infection[2] | \-  | \+  | \+  | \+  | +/-  | \-  | Local erythema | Leukocytosis, Normocytic normochromic anemia | ↑  | Moderately elevated WBC counts (neutrophilic predominance), low glucose, and increased protein | PPD |  Tissue swelling, Bone destruction with normal joint space, Osteopenia | Vertebral anterior portion collapse  | Complicated effusion with partial joint destruction and erosion in MRI | Granulomatous inflammation | Synovial fluid culture  | Limping, Malaise, Chronic cough
Lyme disease[3] | \+  | \+  | +/-  | +/-  | \-  | \-  | 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
Systemic disorders | Rheumatoid arthritis[4] | \+  | \-  | \+  | \+  | \+  | \-  | 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[5] | \+  | \+  | \+  | +/-  | \-  | \-  | 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[edit | edit source]

1. ↑ Askling J (October 2007). "Malignancy and rheumatoid arthritis". Curr Rheumatol Rep. 9 (5): 421–6. PMID 17915099.
2. ↑ Gardam M, Lim S (December 2005). "Mycobacterial osteomyelitis and arthritis". Infect. Dis. Clin. North Am. 19 (4): 819–30. doi:10.1016/j.idc.2005.07.008. PMID 16297734.
3. ↑ 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.
4. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
5. ↑ 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)