Oct, 20 precepts usefulness of signs of inflammation in differential diagnosis of painful joints noninflammatory arthritis. Differential diagnosis johns hopkins arthritis center. The guideline summarizes current recommendations for diagnosis and treatment of ra for patients 16 years of age and older. Arthritis and differential inflammatory joint disorders.
Differential diagnosis of rheumatoid arthritis the american journal. Other causes joints pain also could exists in pso patients like osteoarthritis, gouty arthritis, septic arthritis, and trauma and should be always considered in the differential diagnosis of. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. Get a printable copy pdf file of the complete article 773k. Approach to diagnosis of arthritis linkedin slideshare. Full text is available as a scanned copy of the original print version.
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. Rheumatoid arthritis approach to a patient and differential diagnosis by m. 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. September 30, 2012 scope this guideline is intended to aid in early recognition, intervention and management of patients with rheumatoid arthritis ra. Nonsteroidal antiinflammatory drugs are the treatment of choice. Get a printable copy pdf file of the complete article 356k, or click on a page image below to browse page by page. Diagnosis, management and monitoring effective date. Rheumatoid arthritis ra is a symmetric, inflammatory, peripheral polyarthritis of unknown etiology.
A definitive diagnosis depends on distinguishing osteoarthritis from those other types of arthritis. Apr 19, 2020 a definitive diagnosis depends on distinguishing osteoarthritis from those other types of arthritis. 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. Xii siegenthaler, differential diagnosis in internal medicine isbn97831421418, 2007 georg thieme verlag 3. The differential diagnosis ranges from a benign, selflimiting illness to complex multisystem and lifethreatening diseases such as systemic lupus erythematosus and severe rheumatoid arthritis. It typically results in warm, swollen, and painful joints. Consider sjogren syndrome in the differential diagnosis. Tuberculous arthritis in a nonweightbearing joint is a rare form of bony tuberculosis, encountered in only 0.
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. 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. Dec 11, 2014 psoriasis arthritis psa is a chronic inflammatory arthritis of joints of uncertain pathogenesis. This article outlines an approach to basic plainfilm diagnosis and differential diagnosis of the arthritides. Sle is at the last position on the list of differential diagnoses of polyarthritis. Precepts usefulness of signs of inflammation in differential diagnosis of painful joints noninflammatory arthritis. Septic arthritis in children is an orthopaedic emergency. 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. The role of rheumatoid factor its role as a screening test in the diagnosis of rheumatoid arthritis and the use of other diagnostic markers particularly the value of anti ccp antibody test in the diagnosis of early rheumatoid arthritis. Takayasus arteritis as a differential diagnosis of systemic juvenile chronic arthritis.
The examples ct and mr imaging used throughout the text are not all uptodate, stateoftheart images, but they still make appropriate teaching points. Imaging of arthritis and related conditions is almost of teaching file quality, but the novice might appreciate some arrows to indicate the findings. A simplified scoring system integrated with 8 key factors was established for guiding clinical differential diagnosis. Get a printable copy pdf file of the complete article 444k, or click on a page image below to browse page by page. Jul 01, 2015 polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. The disease may also affect other parts of the body. Clinical features of central nervous system infections and. In contrast, inflammatory arthritis generally causes warm. The approach to the differential diagnosis of rheumatic diseases using conventional radiography is systematic and moduleoriented, which, with respect to future developments, forms the basis for computerassisted diagnosis cad. Monoarthritidies have a relatively short differential diagnosis, including. Osteoarthritis differential diagnoses medscape reference. With rheumatoid arthritis there will be fever, pain and swelling with.
Feb 07, 2020 rheumatoid arthritis ra is a chronic systemic inflammatory disease of unknown cause. Takayasus arteritis as a differential diagnosis of. Common septic arthritis osteoarthritis posttraumatic gout charcot joint neuropathic joint pigmented villonodular synovitis pvns synovial osteochondromatos. Differential diagnoses differ in patients with different presentations, but may include conditions such as systemic lupus erythematosus, psoriatic arthritis, and gout. The value of total aortography in the diagnosis of takayasus arteritis. Causes and clinical features of polyarticular joint pain.
This study uses control system theory to model finger skin thermoregulatory processes overlying the hand joint in response to an isometric exercise. Individuals with symptoms of arthritis not attributed to diagnosed conditions individuals with arthritis requiring differential diagnosis of oa from ra individuals with established ra test availability a list of tests that may be useful in ra diagnosis, assessment of prognosis, and followup is provided in table 2. Full text full text is available as a scanned copy of the original print version. Serumsicknesslike disease is a common cause of acute arthritis in children. The designation arthritis deformans, which is generally employed in this country and in germany, seems to me the preferable. Psa may lead to severe disabilities even in the absence of any clinical symptom. Rheumatoid arthritis is a chronic, systemic, inflammatory autoimmune disorder causing symmetrical polyarthritis of large and small joints, typically presenting between the ages of 30 and 50 years. 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. Obtaining a history and performing a physical examination are the first steps in allowing the clinician to accurately characterize the arthritis and approach the differential diagnosis in a focused, logical fashion based on the duration of symptoms, the presence or absence of joint inflammation, the number of joints affected, and the pattern of. Naproxen 500 mg twice daily or indomethacin 2550 mg every 8 hours. Differential diagnosis of rheumatoid arthritis sciencedirect. Markers that are used in clinical practice as in the diagnosis of rheumatoid arthritis. Rheumatoid arthritis differential diagnosis wikidoc.
Apr 17, 2019 rheumatoid arthritis ra is a chronic inflammatory disorder of the small joints of the hands and feet, in which synovial inflammation leads to joint erosion and deformity. Acute arthritis is a prevalent disease in outpatient clinics and. Differential diagnosis of joint pain includes the following. 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. The pseudorheumatoid arthritis form with subacute inflammatory polyarthritis is much less common and differs from rheumatoid arthritis because of the presence of degenerative features, absence of rheumatoid factor and typical marginal erosions on the hands or feet xrays and presence of chondrocalcinosis. Differential diagnosis of rheumatoid arthritis allen h. Early, aggressive therapy to prevent joint damage and. The distinction between inflammatory arthritis and noninflammatory arthritis is a critical bifurcation point in the differential diagnosis of arthritis.
Differential diagnosis a variety of conditions must be considered in the differential diagnosis of rheumatoid arthritis ra. Get a printable copy pdf file of the complete article 773k, or click on a page image below to browse page by page. Rheumatoid arthritis ra is a longterm autoimmune disorder that primarily affects joints. Prompt diagnosis and treatment are critical in optimising patient outcomes.
Degenerative with osteoarthritis there will be swelling due to osteophyates, and possibly thickened synovium or effusion. 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. 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. It is an autoimmune condition which predominantly affects joints and has systemic extraarticular manifestations as well. Differential diagnosis of knee pain november 11, 2016. Initial laboratory evaluation should also include complete blood count with dif ferential and assessment of renal and hepatic function. Once inflammatory arthritis is suspected, possible diagnoses are sorted by the pattern of joint involvement, which includes number and type of. It recommends the concept of dividing up the arthritides into those in which the radiological effects predominantly affect synovium, cartilage. Differential diagnosis of polyarticular arthritis american. Osteoarthritis is the most common type of joint disease, affecting more than 20 million individuals in the united states alone see epidemiology. Mismanagement can lead to serious adverse outcomes, including systemic sepsis, cartilage destruction, growth plate damage and avascular necrosis of the femoral head figure 1.
The most reliable means for making this distinction is analysis of the white blood cell wbc count in the synovial fluid. James r odell, md editorinchief rheumatology section editor rheumatoid arthritis bruce professor and vice chairman internal medicine university of nebraska medical center. Imaging of arthritis and related conditions with clinical. Arthritis is a common cause of pain and disability in adults. Monoarthritis differential radiology reference article. This is a diagnosis of exclusion, so other causes of arthritis must be ruled out. Adjunct associate professor of bioengineering, department of mechanical and materials. Diagnosis and management of psoriatic arthritis request pdf. With rheumatoid arthritis there will be fever, pain and swelling with decreased range of movement and synovial thickening. Rheumatoid arthritis ra is a chronic inflammatory disorder of the small joints of the hands and feet, in which synovial inflammation leads to joint erosion and deformity.
Erosive arthritis has a broad differential, including. The first step is to distinguish between true articular pain and nonarticular or periarticular. The indications follow consensusbased referral criteria and. Clinical and immunogenetic differentiation from rheumatoid arthritis. 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. Erosive arthritis differential radiology reference.
School of medicine, national yangming university, taipei, taiwan. 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. Differential diagnosis of polyarticular arthritis american family. Takayasus arteritis as a differential diagnosis of systemic. Osteoarthritis usually presents with less than one hour of morning stiffness and pain that is aggravated by activity and improves with rest. Therefore, psa diagnosis in its early stages is critical. For the most part, the differential diagnosis of monoarthritis or oligoarthritis 24 joints differs from that for polyarthritis. Diagnosis and differential diagnosis of rheumatoid arthritis. Functionalthermoregulatory model for the differential. By setting the cutoff value at 4 and verifying in a group of sle patients complicated with newly occurred suspected cns infection or npsle, a sensitivity of 85. Differential diagnosis of polyarthritispolyarthralgia. Pdf polyarthritis and its differential diagnosis researchgate. Polyarthritis and its differential diagnosis european journal of. Should be continued until the symptoms have resolved usually 510 days.
A diagnostic approach to the common arthritic conditions. 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. 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. Links to pubmed are also available for selected references. Siegenthaler, differential diagnosis in internal medicine.