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Arthritis

Arthritis is inflammation of one or more joints. There are two major categories of arthritis.  

The first type is caused by wear and tear on the articular cartilage (Osteoarthritis) through the natural aging process, through constant use, or through trauma (post-traumatic arthritis). The second type is caused by one of a number of inflammatory processes. 

 

Monoarticular Arthritis 

Most common diagnoses in acute monoarticular arthritis: crystalline, septic, osteoarthritis, trauma. 

Most important diagnostic test in acute monoarticular arthritis: synovial fluid analysis and culture. 

Most important diagnoses to rule out in chronic monoarticular arthritis: indolent infection, tumor. 

Best diagnostic tests in chronic monoarticular arthritis: synovial fluid analysis, radiography, magnetic resonance imaging, arthroscopy with synovial biopsy and culture. 

  

Diseases that Commonly Present with Monoarthritis 

Septic diseases, Bacterial, Mycobacterial, Lyme disease, Fungal, Crystal deposition diseases, Gout, Calcium pyrophosphate dihydrate deposition disease (pseudogout), Hydroxyapatite deposition disease, Calcium oxalate deposition disease, Traumatic, Fracture, Internal derangement, Hemarthrosis, Other diseases, Osteoarthritis, Juvenile idiopathic arthritis, Coagulopathy, Avascular necrosis of bone, Foreign-body synovitis, Pigmented villonodular synovitis, Palindromic rheumatism 

 

Inflammatory and Noninflammatory Causes of Chronic Monoarthritis 

INFLAMMATORY 

NONINFLAMMATORY 

Mycobacterial infection 

Osteoarthritis 

Fungal infection 

Internal derangement of the knee 

Lyme arthritis 

Avascular necrosis of bone 

Monoarticular presentation of rheumatoid arthritis 

Pigmented villonodular synovitis 

Seronegative spondyloarthropathies 

Synovial chondromatosis 

Sarcoid arthritis 

Synovioma 

Foreign-body synovitis 

 

  

Polyarticular Arthritis 

The history and physical examination, not laboratory testing, are the best tools for diagnosis.  

The two most common causes of polyarthritis are osteoarthritis and rheumatoid arthritis. 

The extraarticular features (such as the malar rash of systemic lupus erythematosus, SLE) are often key to diagnosing polyarticular syndromes. 

Laboratory tests are most useful in confirming a diagnosis based on the history and physical examination. 

 

Diseases with Acute Polyarthritis Symptoms  

INFECTION 

OTHER INFLAMMATORY CONDITIONS 

Gonococcal 

Rheumatoid arthritis 

Meningococcal 

Polyarticular and systemic JIA 

Lyme 

Acute sarcoid arthritis 

Acute rheumatic fever 

Systemic lupus erythematosus 

Infective endocarditis 

Reactive arthritis 

Viral (especially rubella, hepatitis B and C, parvovirus, Epstein–Barr, HIV) 

Psoriatic arthritis 

 

Polyarticular gout 

 

Distribution of Joint Involvement in Polyarthritis  

DISEASE 

JOINTS COMMONLY INVOLVED 

JOINTS COMMONLY SPARED 

Gonococcal arthritis 

Knee, wrist, ankle, hand IP 

Axial 

Lyme arthritis 

Knee, shoulder, wrist, elbow 

Axial 

Rheumatoid arthritis 

Wrist, MCP, PIP, elbow, glenohumeral, cervical spine, hip, knee, ankle, tarsal, MTP 

DIP, thoracolumbar spine 

Osteoarthritis 

First CMC, DIP, PIP, cervical spine, thoracolumbar spine, hip, knee, first MTP, toe IP 

MCP, wrist, elbow, gleno-shoulder, ankle, tarsal 

Reactive arthritis 

Knee, ankle, tarsal, MTP, first toe IP, elbow, axial 

Hip 

Psoriatic arthritis 

Knee, ankle, MTP, first toe IP, wrist, MCP, hand IP, axial 

 

Enteropathic arthritis 

Knee, ankle, elbow, shoulder, MCP, PIP, wrist, axial 

 

Polyarticular gout 

First MTP, instep, heel, ankle, knee 

Axial 

CPPD disease 

Knee, wrist, shoulder, ankle, MCP, hand IP, hip, elbow 

Axial 

Sarcoid arthritis 

Ankle, knee 

Axial 

Hemochromatosis 

MCP, wrist, ankle, knee, hip, feet, shoulder 

 

  CMC, Carpometacarpal; DIP, distal interphalangeal; IP, Interphalangeal; MCP, metacarpophalangeal; MTP, metatarsophalangeal. PIP, proximal interphalangeal;  

 

 

  

Synovial Fluid Analysis 

  

normal 

Noninflammatory 

Inflammatory 

Septic 

Hemorrhagic 

Color 

clear 

clear 

turbid 

turbid 

bloody 

Viscosity 

high 

high 

low 

various 

various 

wbc/mm3 

<200 

≤2000 

>2000 

>50000 

Various 

PMN (%)

<25 

≤25 

>25 

>50 

various 

 wbc/mm3 = Granulocytes/mm3, PMN = polymorphonuclear leukocytes


Pubmed

UpToDate

Images


Videos: 

Arthritis / Arthrose - Teil 1 

Arthritis / Arthrose - Teil 2 


Web: 

Physical Activity for Arthritis - CDC 

Mayoclinic 

Arthritis Foundation


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