Certain key historical elements can help narrow the differential diagnosis. Basic differential diagnosis of arthritis 1 4 2 3 fig. Symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Dermatological features of psoriasis precede arthritis in 65% range 6070% whereas arthritic symptoms proceed dermatological features in 1520% 11. If you dont diagnose and treat it in time, it could harm your joints. Pdf polyarthritis is a term used when at least five joints are affected with arthritis. For example, in a young male patient, systemic lupus erythematous sle is at the last position on the list of differential diagnoses of polyarthritis. Rheumatoid arthritis ra is a chronic systemic inflammatory disease of unknown cause. Methods 18 ra patients and 20 psa patients with clinical involvement of mcp joints were included. Available in portable document format pdf from the british columbia ministry of health web site.
Diagnosis, management and monitoring effective date. Markers that are used in clinical practice as in the diagnosis of rheumatoid arthritis. Churchills pocketbook of differential diagnosis is the best book you can use in clinical practice to approach a sign or symptom more thoroughly. Rheumatoid arthritis is a systemic autoimmune inflammatory disorder that attacks the synovial tissues around joints goodman. All us examinations were performed by two rheumatologists investigating. Osteoarthritis and rheumatoid arthritis 2012 nurse practitioner. Results primarily from alterations in the structure or mechanics of the joint the joint disease may occur as a result of degenerative, traumatic or mechanical damage with noninflammatory joint disease. This article outlines an approach to basic plainfilm diagnosis and differential diagnosis of the arthritides. This is a diagnosis of exclusion, so other causes of arthritis must be ruled out. Monoarthritis differential radiology reference article. Find out how the tests are used and what they involve. Differential diagnosis between rheumatoid arthritis and. A single symptom or a single test result is not enough to diagnose a specific type of arthritis or rheumatic disease. Rheumatoid arthritis ra is a longterm autoimmune disorder that primarily affects joints.
To overcome this difficulty a number of modifica 346 i. A diagnostic approach to the common arthritic conditions. Differential diagnosis of rheumatoid arthritis sciencedirect. Pdf polyarthritis and its differential diagnosis researchgate. The evaluation of patients with polyarticular pain is described in detail separately see evaluation of the adult with polyarticular pain, and the features of disorders that are included in the differential. Differential diagnosis of polyarthritispolyarthralgia.
Churchills pocketbook of differential diagnosis download. Recently, elderly onset ra is increasing, that has relatively higher ratio of seronegative than young onset ra. Certain symptom patterns and tests are combined to rule out certain diseases and rule in a definitive diagnosis. If one may judge from the multiplicity of names that have been applied to arthritis deformans its nature is not so well understood, and i am confident that it o. Rheumatoid arthritis ra should be suspected in the adult patient who presents with inflammatory polyarthritis. Churchills pocketbook of differential diagnosis pdf 4th. Pain in the knees bilateral knee swelling patella tap positive limited range of movement. Tests for diagnosing arthritis blood tests, imaging tests, and samples of joint fluid are a few of the ways doctors diagnose arthritis. Marked warmth and erythema in a joint suggests a crystalline etiology. Other symptoms may include fever, weakness and headache. Rheumatoid arthritis differential diagnosis wikidoc. Background the acreular classification criteria aecc for rheumatoid arthritis ra is well known criteria for early diagnosis of ra with high sensitivity. Polyarthritis, differential diagnosis, laboratory investigations.
Arthrocentesis aspiration of the joint can help aid in distinuishing between these types of arthritis if the diagnosis is not clear by history, physical exam, and radiographs. Osteoarthritis differential diagnoses medscape emedicine. Diagnosis and differential diagnosis article pdf available in korean journal of pediatrics 5311. Approach to a patient with ra the original treatment pyramid for ra is now considered to be obsolete and has evolved into a new strategy that focuses on several goals. Adjunct associate professor of bioengineering, department of mechanical and materials. Large vessel vasculitis is a rare cause of polyarthritis. Septic arthritis, also known as joint infection or infectious arthritis, is the invasion of a joint by an infectious agent resulting in joint inflammation. The specific joints involved, as well as the presence or lack of certain systemic symptoms fatigue, weight loss, lack of appetite, fever, malaise, are primarily what is considered to distinguish or differentiate osteoarthritis.
Osteoarthritis is associated with specific risk factors or causes including age, joint. The differential diagnosis of these diseases is a very important matter, and it is all. Early, aggressive therapy to prevent joint damage and. Attacks of gout and septic arthritis tend to have an acute onset, reaching a peak within days, whereas in ra, onset is usually over weeks to. Inflammatory arthritis early stage, suspected diagnosis refer to rheumatologist for workup learn tests to order to work up for yourself sed rate, rheum factor, anti ccp antibodies, ana.
It gives the users a wide insight as what can be expected from the patients when they come to doctor with certain complaints or what physical finding one obtains upon examination. Differential diagnosis of lesions at the knee disorder diagnosis treatment anterior knee pain patellar bursitis inspection and palpation aspirationinfiltration or surgery subsynovial haematoma history of local blow aspiration marked limitation of flexion normal extension suprapatellar tendinitis painful resisted extension deep friction or. Prolonged stiffness greater than one hour should raise suspicion for an inflammatory arthritis such as rheumatoid arthritis. Several symptoms that indicate arthritis are not necessarily diagnostic of jia, and may have multiple etiologies that can be differentiated with careful examination of patient history3. Differential diagnosis johns hopkins arthritis center. These children usually have multiple joint involvement lasting more than six continuous weeks with the cervical spine often affected. Brigham and womens hospital disclosures cvs conclusion a new era in the treatment of rheumatoid arthritis proof of principle has been established that proof of principle has been established that selective targeting of pathogenic. In contrast, inflammatory arthritis generally causes warm. Educational commentary is provided through our affiliation with the american society for clinical pathology ascp.
Approach to diagnosis of arthritis linkedin slideshare. Pdf a 60yearold male was sent to the emergency room for acuteonset right ankle pain with mild fever in the early morning. Points against 50 years old woman pain more in the evening, decreases on rest swellings on the distal interphalangeal. To obtain free cmecmle credits, click on earn ce credits under continuing education on the left side of the screen. If the distribution of painful joints includes mcp, wrist, elbow, ankle or shoulder, oa is unlikely, unless there are specific risk factors such as occupational, sportsrelated, history of injury. Most people with ra do have some sort of joint damage. The guideline summarizes current recommendations for diagnosis and treatment of ra for patients 16 years of age and older. Differential diagnosis of rheumatoid arthritis allen h. A definitive diagnosis depends on distinguishing osteoarthritis from those other types of arthritis.
Cleveland, ohio the differential diagnosis of subacute or chronic polyarthritic diseases, including rheumatoid arthritis, is based on recognizing a pattern of changes, with special emphasis placed on certain key features that possess higher specificity. Differential diagnosis of knee pain november 11, 2016. The differential diagnosis of gout, rheumatism, and. The hallmark feature of this condition is persistent symmetric polyarthritis synovitis that affects the hands and feet, though any joint lined by a synovial membrane may be involved. Common septic arthritis osteoarthritis posttraumatic gout charcot joint neuropathic joint pigmented villonodular synovitis pvns synovial osteochondromatos. It advocates the use of an analysis of which part of the joint is involved, and works through a logical sequence to reach a final diagnosis. Arthritis and differential inflammatory joint disorders. Rheumatoid arthritis is associated with prominent, prolonged 1 hour morning stiffness and overtly swollen, warm joints. Presence of erythema, warmth, swelling, pain with passive rom, morning stiffness suggests inflammatory cause arthritis.
Joint findings include swelling with thickening of. Rheumatology associates of houston, a division of nw diagnostic clinic. Table 1 summarizes clini cal patterns that are helpful in the diagnosis of polyar ticular arthritis. Rheumatoid arthritis differential diagnosis and treatment. Making it even more complicated is the possibility of having more than one rheumatic. Rheumatic fever is characterized by the migratory nature of the arthritis, an elevated antistreptolysin o titer, and a more dramatic and prompt response to aspirin. The mode and pattern of onset help to narrow the differential diagnosis. Osteoarthritis usually presents with less than one hour of morning stiffness and pain that is aggravated by activity and improves with rest. Basic differential diagnosis of arthritis springerlink. The disease may also affect other parts of the body. Gouty arthritis dasheni puvanaendran gomalah ganeswaran kahmini manoharan. It recommends the concept of dividing up the arthritides into those in which the radiological effects predominantly affect synovium, cartilage. Differential diagnoses differ in patients with different presentations, but may include conditions such as systemic lupus erythematosus, psoriatic arthritis, and gout.
The initial evaluation of such patients requires a careful history and physical examination, along with selected laboratory testing to identify features that are characteristic of ra or that suggest an alternative diagnosis. Rheumatoid arthritis approach to a patient and differential diagnosis by m. Target failure is defined as either failure to achieve the treatment target primary failure or failing to. Differential diagnosis of polyarticular arthritis american family. The diagnostic criteria for jia include disease onset before the age of 16 years, the presence of arthritis in one or more joints for at least 6 weeks, onset type defined by type of disease in the first 6 months of diagnosis, and exclusion of other forms of juvenile arthritis. Differentiation of rheumatoid arthritis ra from other diseases of connective tissue can be difficult. Rheumatoid arthritis ra is a symmetric, inflammatory, peripheral. Polyarticular joint disease has a multifactorial etiology, and may present as a viral illness or can be the. Objective to investigate the potential of ultrasound us in the differential diagnosis between rheumatoid arthritis ra and psoriatic arthritis psa at metacarpophalangeal mcp joints level. Recently, it was understood that petct contributes to the differential diagnosis of large vessel vasculitis. In addition, if arthritis is suspected, mri may be helpful in demonstrating synovitis. Systemic onset juvenile rheumatoid arthritis jra 1 often follows a respiratory infection and has intermittent and persistent fever greater than 103 f 39 c accompanied by classic rheumatoid rash. Precepts usefulness of signs of inflammation in differential diagnosis of painful joints noninflammatory arthritis.
The differential diagnosis ranges from a benign, selflimiting illness to complex multisystem and lifethreatening diseases such as systemic lupus erythematosus and severe rheumatoid arthritis. Can have completely pain free days, estimates joint pain on 34 days per week. Diagnosis and differential diagnosis of rheumatoid arthritis. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. In contrast to many other arthropathies, there is no gender predilection in psoriatic arthritis. Diagnosis and differential diagnosis of rheumatoid arthritis uptodate. Rheumatoid arthritis differential diagnosis of the knee. Although our patient did not have involvement of the cartilage of the nose and ear, relapsing polychondritis is also included in the differential of migratory polyarthritis. Serumsicknesslike disease is a common cause of acute arthritis in children. Petct is helpful in making a differential diagnosis in cases with suspected malignancy. This diagnosis is determined by examining three important factors goodman. These attacks result in excessive proliferation of the synovial tissue and formation of granular tissues called pannus formations walther. Target sustained indicates that remission or low disease activity was maintained for at least 6 months. Differential diagnosis for arthritis many joints polyarthiritis common and important causes of arthritis many joints polyarthiritis for doctors and medical students this page is currently being written and will be available soon.
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