Arthritis
Arthritis is inflammation of one or more joints. There are two major categories of arthritis.
Monoarticular Arthritis
Most common diagnoses in acute monoarticular arthritis: crystalline, septic
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, 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
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
Videos:
Web:
Physical Activity for Arthritis - CDC
Intermittentent Arthritis
Periodic Syndormes
Intermittent hydrarthrosis
Palindormer Rheumatismus
FMF
Hyperimmunglobulin D und periodisches Fieber
RS3PE
"Tietze"
Kristallarhtritiden: Gicht CPPD Hydroxyapatit
Sarkoidose
SpA
Infektionen: Lyme Whipple
Mechanisch: Meniskusriss Gelenkskörpe
Arhtritis mutilans
Psoriasis
RA
Gicht
MRH
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