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

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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
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[edit | edit source]

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.CS1 maint: Multiple names: authors list (link)
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.