Differential diagnosis of osteoarthritis verywell health. Feb 07, 2020 rheumatoid arthritis ra is a chronic systemic inflammatory disease of unknown cause. Jul 25, 2019 juvenile rheumatoid arthritis jra is the most common chronic rheumatologic disease in children and is one of the most common chronic diseases of childhood see the image below. The differential diagnosis ranges from a benign, selflimiting illness to complex multisystem and lifethreatening diseases such as systemic lupus erythematosus and severe rheumatoid arthritis. Polyarticular arthropathy can arise from a number of causes. Albanoaluquin, md, pennsylvania state university college of. Nov 20, 2012 pediatric annals cme educational objectives 1. Diagnosis and differential diagnosis of rheumatoid arthritis uptodate. Polyarticular joint disease has a multifactorial etiology, and. Minor abnormalities of motor func tion are readily appreciated and become a serious source of concern when lifestyles are compromised.
Tophi and high levels of uric acid are specific for gout, but are very rare in ra. Medicinenet does not provide medical advice, diagnosis or treatment. The clinical features of this disorder, its extraarticular manifestations, and laboratory markers that are clinically useful in the diagnosis of ra are discussed in detail separately. Juvenile idiopathic arthritis differential diagnoses. It typically leads to deformity through the stretching of tendons and ligaments and destruction of joints through the erosion of cartilage and bone. Polyarticular disease is more serious and tends to affect the small joints, such as the hands and feet, and often on both sides of the body. Juvenile idiopathic arthritis jia is a heterogeneous group of conditions which encompasses all forms of arthritis of unknown etiology lasting for at least 6 weeks and with onset before the age of 16 years. Many people are familiar with what rheumatoid arthritis is and the joint pain that it causes. Monoarticular oligoarticular arthritis diagnosisdude. Juvenile idiopathic arthritis differentials bmj best practice.
Arthritis can be divided into two broad categories. Shbeeb and coworkers 12 described a 3% prevalence of polyarthritis at onset, whereas in hospital series polyarthritis may affect 15% to 61% of individuals. Differential diagnosis of polyarticular arthritis mayo clinic. The first step is to distinguish between true articular pain and nonarticular or periarticular conditions by recognizing clinical patterns through the history and physical examination. Juvenile idiopathic arthritis jia is the most common chronic arthropathy of childhood.
A diagnostic approach to the common arthritic conditions sa fam pract 2009 188 vol 51 no 3 abstract arthritis is a common cause of pain and disability in adults. Jul 01, 2015 differential diagnosis of polyarticular arthritis. The guideline summarizes current recommendations for diagnosis and treatment of ra for patients 16 years of age and older. Oct 31, 2019 assessment of osteoarthritis and rheumatoid arthritis diagnosing osteoarthritis the diagnosis of oa is based on patient history as well as the physical exam table 1. Approach to polyarthritis for the primary care physician. Differential diagnosis of polyarticular arthritis mayo. T1 differential diagnosis of polyarticular arthritis. While most people know that osteoarthritis is the most common type of arthritis, what distinguishes it from other types. Rheumatoid arthritis ra is a symmetric, inflammatory, peripheral polyarthritis of unknown etiology. Table 1 summarizes clini cal patterns that are helpful in the diagnosis of polyar ticular arthritis. 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. Huffman all of mans activities of daily living depend on normal ambulation and dexterity. Tophi and high levels of uric acid are specific for gout and very rare in ra.
Polyarticular joint disease has a multifactorial etiology, and may present as a viral illness or can be the beginning of a chronic disease. Differential diagnosis of polyarthritispolyarthralgia. Nonerosive, migratory, may resolve in a given joint in physical findings. A complete history and physical examination are appropriate for all patients presenting with polyarticular joint pain, since this symptom may be the initial manifestation of a systemic illness. This is a diagnosis of exclusion, so other causes of arthritis must be ruled out. In the event that pain is the only symptom, it is difficult to differentiate polyarthritis from the causes of polyarticular joint pain pjp, such as. Request pdf differential diagnosis of polyarticular arthritis polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies.
Figure 71 a 15yearold girl with polyarticular juvenile idiopathic arthritis. Joint pain arthralgias, polyarticularpolyarthritis. Symmetric polyarticular psoriatic arthritis affecting all the proximal interphalangeal joints of the fingers except the left ring finger pip joint which seems to be protected by wearing a golden ring. In addition, erosions seen in gout where the tophi have eroded into the bone are different from the erosions seen in ra. Diagnosis, management and monitoring effective date. Arthritis is a common cause of disability in childhood. Identifying the cause of polyarticular joint pain can be difficult because of the extensive differential diagnosis. Diagnosis and differential diagnosis of rheumatoid. Dao key points polyarthritis is pain of synovial or articular origin, with or without inflammation, in four or more joints. Differential diagnosis of polyarticular arthritis american family.
In this article, the first in a series of two articles on arthritis, a clinical approach to. In some cases, polyarthritis can be severe enough to necessitate the admission of patients. Juvenile idiopathic arthritis jia is the most common chronic arthropathy of children and includes several subtypes including oligoarticular, polyarticular, and systemic onset. Juvenile idiopathic arthritis is the most common cause of chronic arthritis in childhood. What is the most important condition in the differential diagnosis of juvenile idiopathic arthritis jia. Symmetric polyarticular psoriatic arthritis affecting a openi. For the most part, the differential diagnosis of monoarthritis or oligoarthritis 24 joints differs from that for polyarthritis. Diagnosis and management of juvenile idiopathic arthritis. Pujalte, md, mayo clinic health system, waycross, georgia shirley a. The history and physical examination are essential elements for diagnosis.
Biopsy is the only method to distinguish benign rheumatoid nodules from sga. Become familiar with the clinical presentation, differential diagnosis and potential complications of systemic juvenile idiopathic arthritis. If a child, or a teen younger than 16, has joint inflammation and stiffness for more than 6 weeks, it may be juvenile rheumatoid arthritis, or jra the inflammation can cause redness, swelling. Juvenile idiopathic arthritis jia, is the most common, chronic rheumatic disease of childhood, affecting approximately one per children. Polyarticular gout or rheumatoid arthritis a search. Idiopathic multicentric carpotarsal osteolysis mcto is a congenital disease, liked to mafbgene mutation, described in 2012. Polyarticular arthropathy radiology reference article.
Differential diagnosis of polyarticular arthritis american. Arthritis differential diagnosis table pregnancy after wrist. The severity of lameness can vary markedly, and a shifting leg lameness often occurs. A diagnostic approach to the common arthritic conditions. Arthritis differential diagnosis table pregnancy after. If the site of the patients pain is articular, classifying whetherthe arthritis is monoarticular eg, septic arthritis or gout or polyarticular may aid in diagnosis.
Juvenile, in this context, refers to disease onset before age 16 years, while idiopathic refers to a condition with no defined cause, and arthritis is inflammation within the joint. This term encompasses several disease categories, each of which has distinct presentation, clinical manifestations, and, presumably, genetic background and etiopathogenesis. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. September 30, 2012 scope this guideline is intended to aid in early recognition, intervention and management of patients with rheumatoid arthritis ra. Differentiating crystal from rheumatoid arthritis is vital as the treatment paradigms for. Exclude fibromyalgia as a cause of pain, and evaluate for common causes such as osteoarthritis. Juvenile rheumatoid arthritis jra is the most common chronic rheumatologic disease in children and is one of the most common chronic diseases of childhood see the image below. Osteoarthritis usually presents with less than one hour of morning stiffness and pain that is aggravated by activity and improves with rest. 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. Noninflammatory arthritis, which is mostly related to osteoarthritis, does not have inflammatory features, such as warm or swollen joints. Diseases with similar clinical features have been excluded, particularly psoriatic arthritis, acute viral polyarthritis, polyarticular gout or calcium. Box 72 differential diagnosis of juvenile idiopathic arthritis. Rheumatoid arthritis differentials bmj best practice. Diagnostic approach to polyarticular joint pain american.
Myofascial pain fibromyalgia when it is early in the course of symptoms, differentiating among these causes is often difficult for anyone. With this framework, the orthopaedic specialist should be able to identify children with juvenile arthritis and to differentiate arthritis from benign pains of childhood, psychogenic pain syndromes, benign musculoskeletal back pain. However, some dogs may present as chronic lameness without signs of systemic disease. In contrast, inflammatory arthritis generally causes warm. Juvenile idiopathic arthritis changing times, changing. A good anamnesis and physical examination are the main pillar of the differential diagnosis of polyarthritis. Differential diagnosis of polyarticular arthritis george g. Juvenile idiopathic arthritis differentials bmj best. Symmetric polyarticular psoriatic arthritis affecting a. The etiology is unknown, and the genetic component is complex, making clear distinctions between the various subtypes difficult. 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. The first step is to distinguish between true articular pain and nonarticular or periarticular conditions by recognizing clinical patterns through the history and physical.
Differential diagnosis for wrist and hand flashcards. Previous terminology identified this entity as juvenile rheumatoid arthritis. Psoriatic nail changes are also evident in this photo. Juvenile, in this context, refers to disease onset before age 16 years, while idiopathic refers to a condition with no defined cause, and. Differential diagnosis of polyarticular arthritis request pdf. The 7 subsets of jia identified under the new classification system are discussed, as are current treatments. Systemic signs such as fevers, chills, and a vesicular rash are common. Diagnosis and differential diagnosis of rheumatoid arthritis. The list includes osteoarthritis erosive osteoarthritis rheumatoid arthritis psoriatic arthritis reiters syndrome ankylosing spondylitis gout cppd hemochromatosis ochronosis. As a result of the lack of pathognomonic features, the diagnosis of jia is one of exclusion among all possible causes of chronic arthritis in childhood. Mcto is characterized by progressing osteolysis, mostly of carpal and tarsal bones, leading to articular. Arthritis and differential inflammatory joint disorders.
Jul 01, 2015 differential diagnosis of polyarticular arthritis george g. The 7 subsets of jia identified under the new classification system are discussed, as are current. Differential diagnosis of juvenile idiopathic arthritis. Causes and clinical features of polyarticular joint pain. Apr 19, 2020 the differential diagnosis of osteoarthritis focuses on characteristics that set it apart from other types of arthritis.
The differential diagnosis of rheumatoid arthritis by gary s. Background rare genetic pathologies involving the musculoskeletal system can be erroneously misdiagnosed as juvenile idiopathic arthritis jia. Nearly 50 percent of children with jra are affected by this type of the disease, which affects five or more joints. What is the most important condition in the differential. The first step is to distinguish between true articular pain and nonarticular or periarticular. Before delving in, a word about the uncommon but worstcase scenario acute onset new monoarticular arthritis which might be a septic joint if suspicious, an e. Dec 27, 2018 medicinenet does not provide medical advice, diagnosis or treatment.
Polyarthritis and its differential diagnosis european journal of. The list of causes of polyarticular pain is lengthy and includes. Formulate a differential diagnosis for children with joint pain. Small percentage of gout patients present with polyarticular gout, and can mimic ra. N2 polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. Here are some key facts to know about polyarticular rheumatoid arthritis and its relationship to rheumatoid. Recognize the longterm complications associated with jia. The differential diagnosis of osteoarthritis focuses on characteristics that set it apart from other types of arthritis. Polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. Rheumatoid arthritis ra is a chronic systemic inflammatory disease of unknown cause.
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