Patients with inflammatory polyarthritis (i.e., inflammation in more than 4 joints) are a diagnostic and administration challenge. When signs are of recent onset, the vary of doable diagnoses is great. Certain viruses together with those that trigger rubella, and mumps, human parvovirus B19 and a few enteroviruses may cause acute polyarthritis; however, these viral arthritides normally subside inside 6 weeks without sequelae. The prodrome of acute hepatitis B infection and an infection with the Lyme disease agent, Borrelia burgdorferi, might embody polyarthritis. The previous is acknowledged by the following hepatitis, while the latter requires an excessive index of suspicion (i.e., a historical past of tick chunk or a typical rash on an affected person from an endemic space) and sometimes entails only 1 or 2 giant joints.
In sufferers who're underneath 50 years of age with joint pain and swelling lasting longer than 6 weeks the diagnoses to be thought-about embrace rheumatoid arthritis, psoriatic arthritis, other seronegative spondyloarthropathies and SLE. In patients over 50 years of age, crystal-induced synovitis should also be considered. Osteoarthritis may additionally cause appreciable irritation within the affected joints. For most of these circumstances specific therapies geared toward controlling inflammation, preserving vary of movement in the joint and preventing joint injury are successful in decreasing morbidity and enhancing high quality of life.
The patient with symptoms in many joints requires an in depth history and bodily examination. If there may be morning stiffness lasting more than 30 minutes or stiffness after sitting, the joint complaints are more likely to be caused by inflammation; a convincing historical past of joint swelling confirms the presence of inflammation. The physician should document the onset and development of signs and the distribution of joints affected. A historical past of psoriasis in the affected person or a member of the family is a vital clue to the opportunity of psoriatic arthritis.
The physician also needs to inquire a couple of historical past of iritis or inflammatory bowel illness, both of which are related to seronegative spondyloarthropathies. A latest episode of infectious diarrhea or genitourinary infection are clues to doable Reiter's syndrome. Does the affected person have symptoms suggestive of SLE (e.g., photosensitive or malar rash, alopecia or pleurisy)? Is there a previous history of acute episodes of arthritis or gout? Are the joints tender or swollen? Is motion restricted? The selection of laboratory exams that may help depend upon the differential diagnosis.
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