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Best Practice & Research. Clinical... Dec 2014Polyarthritis comprises a large number of conditions ranging from rheumatoid arthritis (RA) to metabolic conditions such as ochronosis. Differential diagnosis begins... (Review)
Review
Polyarthritis comprises a large number of conditions ranging from rheumatoid arthritis (RA) to metabolic conditions such as ochronosis. Differential diagnosis begins with delineation of inflammatory from non-inflammatory disorders using laboratory markers of inflammation. The latter are good but they can be misleading. Laboratory tests help in the diagnosis of rheumatic diseases as well as their prognostication. The choice of serological tests should be based on clinical differential diagnosis and not 'arthritis panels'. The point of time when the test is performed in the clinical course of disease can have an important influence on the result obtained. Anti-citrullinated protein antibody (ACPA), rheumatoid factor, human leucocyte antigen (HLA) B27 and imaging are routinely employed for the early diagnosis of RA and spondyloarthritis (SpA). Despite advances in musculoskeletal imaging modalities such as ultrasonography (USG) with power Doppler, conventional as well as extremity magnetic resonance imaging (MRI) and dual-energy computed tomography (DECT), their exact place in clinical rheumatology remains to be defined. Synovial fluid examination has only a limited role in the investigations of new-onset polyarthritis.
Topics: Arthritis; Arthritis, Rheumatoid; Biomarkers; Diagnosis, Differential; Early Diagnosis; Humans; Magnetic Resonance Imaging; Rheumatic Diseases; Rheumatology; Tomography, X-Ray Computed
PubMed: 26096089
DOI: 10.1016/j.berh.2015.04.014 -
Clinics in Podiatric Medicine and... Oct 2016Arthroscopic ankle arthrodesis is a cost-effective option for many patients with posttraumatic arthritis of the ankle joint. Rehabilitation is generally quicker than... (Review)
Review
Arthroscopic ankle arthrodesis is a cost-effective option for many patients with posttraumatic arthritis of the ankle joint. Rehabilitation is generally quicker than conventional open techniques, and rates of fusion are comparable or better than traditional open techniques. Unless the arthroscopic surgeon has considerable experience, the best results are seen in patients with very little deformity in the ankle joint.
Topics: Ankle Injuries; Ankle Joint; Arthritis; Arthrodesis; Arthroscopy; Humans
PubMed: 27599442
DOI: 10.1016/j.cpm.2016.06.006 -
Japanese Journal of Radiology Nov 2023Juvenile idiopathic arthritis (JIA) is a collective term for pediatric inflammatory arthritis of unknown etiology, which presents diverse clinical and imaging findings.... (Review)
Review
Juvenile idiopathic arthritis (JIA) is a collective term for pediatric inflammatory arthritis of unknown etiology, which presents diverse clinical and imaging findings. The pathogenesis is complex; however, most cases stem from an autoimmune mechanism. Herein we provide a short review of imaging findings of JIA. Imaging assessment begins with plain radiography demonstrating joint swelling, periarticular osteopenia, and juxtaarticular bone erosion. Bone erosion occurs later in JIA. Instead, aberrant epimetaphyseal growth often gives the first clue to the diagnosis. US and MRI can demonstrate the details of the synovium, cartilage, and subchondral bone. JIA is subdivided into oligoarthritis, polyarthritis (rheumatoid factor-negative and positive), psoriatic arthritis, enthesitis-related arthritis, and systemic JIA. Awareness of the different clinical characteristics, pathogenic background, and prognosis of each subtype facilitates a more advanced, imaging-based diagnosis. Unlike the other types, systemic JIA is an autoinflammatory disease accompanied by inflammatory cytokinemia and systemic symptoms stemming from aberrant activation of the innate immunity. Other autoinflammatory diseases, both monogenic (e.g., NOMID/CINCA) and multifactorial (e.g., CRMO), are also discussed.
Topics: Child; Humans; Arthritis, Juvenile; Radiography; Magnetic Resonance Imaging; Hereditary Autoinflammatory Diseases
PubMed: 37329408
DOI: 10.1007/s11604-023-01447-6 -
Best Practice & Research. Clinical... Dec 2014Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory.... (Review)
Review
Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogenesis of chronic inflammatory arthritides such as rheumatoid arthritis is increasingly being recognized. We discuss the various causative agents of infective arthritis and emphasize on the approach to each type of arthritis, highlighting the diagnostic tests, along with their statistical accuracy. Various investigations including newer methods such as nucleic acid amplification using polymerase chain reaction are discussed along with the pitfalls in interpreting the tests.
Topics: Arthritis; Arthritis, Infectious; Arthritis, Rheumatoid; Humans; Polymerase Chain Reaction
PubMed: 26096095
DOI: 10.1016/j.berh.2015.04.009 -
The Orthopedic Clinics of North America Oct 2019
Topics: Adult; Arthritis; Child; Humans
PubMed: 31466670
DOI: 10.1016/j.ocl.2019.06.005 -
Casopis Lekaru Ceskych 2016Making the diagnosis of monoarthritis can be quite difficult, because in contrast with polyarthritis just a few clinical data is available and wide diagnostic spectrum... (Review)
Review
Making the diagnosis of monoarthritis can be quite difficult, because in contrast with polyarthritis just a few clinical data is available and wide diagnostic spectrum is present.The diagnosis of inflammatory rheumatic disease is usually in responsibility of a rheumatologist, but we know from experience that is necessary to carry out the basal differential diagnostic assessment as soon as possible to begin the optimal therapy. General practitioners and orthopaedists are usually first to face this problem.Monoarthritis can be divided into non-inflammatory arthritis where activated osteoarthritis and trauma belongs and inflammatory arthritis, which include gouty arthritis, chondrocalcinosis, infectious arthritis, juvenile idiopathic arthritis, spondylitis, incipient rheumatoid arthritis and many others.The article also focuses on the management of patients with monoarthritis where detailed history, careful clinical joint examination and the nature of arthritis assessment is necessary for differential diagnostic considerations. Our balance sheet further facilitate imaging, arthrocentesis with the analysis of synovial fluid and of course the laboratory examination.
Topics: Acute Disease; Arthritis; Arthritis, Infectious; Arthritis, Rheumatoid; Decision Making; Diagnosis, Differential; Humans; Medical History Taking; Osteoarthritis; Physical Examination; Synovial Fluid
PubMed: 27917633
DOI: No ID Found -
American Family Physician Jul 2015Polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. The first step is to distinguish between true articular pain and... (Review)
Review
Polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. 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. Once pain within a joint or joints is confirmed, the next step is to classify the pain as noninflammatory or inflammatory in origin. Noninflammatory arthritis, which is mostly related to osteoarthritis, has a variable onset and severity and does not have inflammatory features, such as warm or swollen joints. Osteoarthritis usually presents with less than one hour of morning stiffness and pain that is aggravated by activity and improves with rest. A review of systems is usually negative for rashes, oral ulcers, or other internal organ involvement. In contrast, inflammatory arthritis generally causes warm, swollen joints; prolonged morning stiffness; and positive findings on a review of systems. Once inflammatory arthritis is suspected, possible diagnoses are sorted by the pattern of joint involvement, which includes number and type of joints involved, symmetry, and onset. The suspicion for inflammatory arthritis should be confirmed by the appropriate serologic/tissue and/or imaging studies in the clinical setting or in consultation with a subspecialist.
Topics: Arthritis; Diagnosis, Differential; Humans; Immunologic Tests; Inflammation; Medical History Taking; Physical Examination; Serologic Tests; Symptom Assessment
PubMed: 26132125
DOI: No ID Found -
Current Rheumatology Reports Jun 2015The literature reports approximately 300 cases of multicentric reticulohistiocytosis (MRH) worldwide, mostly women of Caucasian origin. MRH manifests as a symmetric... (Review)
Review
The literature reports approximately 300 cases of multicentric reticulohistiocytosis (MRH) worldwide, mostly women of Caucasian origin. MRH manifests as a symmetric erosive polyarthritis mimicking rheumatoid arthritis with the subsequent appearance of typical papulonodular skin lesions. The disease may rapidly progress towards mutilans arthritis in the majority of cases, but it generally remits spontaneously in 10 years. The only diagnostic hallmark for MRH is the observation at histology of numerous histiocytes and multinucleated giant cells and ground glass eosinophilic cytoplasm. Despite its rarity, clinical and pathogenetic challenging features characterize the condition. First, the differential diagnosis with other forms of arthritis and the frequent coexistence of neoplasms or autoimmune diseases warrant a careful evaluation of suspected cases. Second, data from isolated MRH cases are consistent in supporting a role for monocyte/macrophage cells and for an enhanced osteoclastic activity in the affected tissues. Third, beside anti-inflammatory treatments, promising reports suggest that biologics targeting TNF-alpha and bisphosphonates may prove beneficial in MRH. Based on these observations, we are convinced that our understanding of this rare condition may prove beneficial in mechanistic advancement for other more prevalent inflammatory conditions such as arthritidies and other bone diseases.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis; Arthritis, Rheumatoid; Diagnosis, Differential; Histiocytosis, Non-Langerhans-Cell; Humans; Rare Diseases; Skin Diseases
PubMed: 25900189
DOI: 10.1007/s11926-015-0511-6 -
Medicine Jul 2022Acute rheumatic fever (ARF) is considered as a disorder of children, and attacks in adults are usually a recurrence of disease acquired in the child's life. Although the...
Acute rheumatic fever (ARF) is considered as a disorder of children, and attacks in adults are usually a recurrence of disease acquired in the child's life. Although the incidence of ARF in children has a decreasing trend in developed countries, resurgent and sporadic epidemics still occur in adults. The first attacks of ARF in adult patients without a childhood history can lead to a diagnostic dilemma. A medical record review in adults at least 18 years of age with an arthralgia complaint fulfilling 2015 revised Jones criteria was performed from January 1, 2000 to December 31, 2019. Eleven ARF patients were identified, including 8 with initial attacks (6 females aged 26-42 years, 33.9 ± 5.3) and 3 pre-existing valvular heart disease with recurrent attacks (2 females aged 38-52 years, 45.0 ± 7.0). In addition to febrile pharyngitis and migratory polyarthritis in initial attacks, pericarditis was encountered in 1, valvulitis in 2, prolong PR interval in 3 and skin involvement in 2 patients with erythema marginatum and IgA vasculitis. All responded to antibiotics and nonsteroidal anti-inflammatory drugs therapy with normalized clinical and laboratory abnormalities, no new-onset carditis, and no recurrent disease during a long-term follow-up (3.8-19.8 years, 12.7 ± 5.4). A sporadic occurrence of adult ARF is observed in southern Taiwan. This disease should be considered by physicians for the differential diagnosis of febrile pharyngitis with arthritis and/or carditis in adults, even in areas with a low incidence of ARF.
Topics: Adolescent; Adult; Arthritis; Child; Female; Fever; Humans; Myocarditis; Pharyngitis; Rheumatic Fever
PubMed: 35777053
DOI: 10.1097/MD.0000000000029833 -
The Journal of Small Animal Practice Mar 2023To provide a description of primary idiopathic immune-mediated polyarthritis, including long-term outcome and relapse rates, for dogs starting treatment with...
OBJECTIVES
To provide a description of primary idiopathic immune-mediated polyarthritis, including long-term outcome and relapse rates, for dogs starting treatment with corticosteroids alone or corticosteroids with a second immunosuppressant.
MATERIALS AND METHODS
Medical records were reviewed between January 2012 and December 2017 to identify dogs diagnosed with primary immune-mediated polyarthritis. Data including signalment, clinicopathological findings, type and duration of treatment, relapse and outcome were recorded.
RESULTS
Seventy-three dogs were included. Fifty-four dogs were started on corticosteroid monotherapy (an additional immunosuppressant was introduced later in 27/54 dogs) and 19 dogs were treated with multi-modal immunosuppression from the outset. Ninety-five percent (69/73) of dogs responded favourably to therapy although death was attributed to immune-mediated polyarthritis in 19% (14/73) of dogs. Relapse of clinical signs was reported in 53% (39/73) dogs (31/39 while on treatment), with multiple relapses observed in 17 dogs. Complete cure (permanent withdrawal of immunosuppressive medication) was achieved in 46 dogs (63%). Overall, 81% of dogs had a well-managed disease for an extended timeframe (≥1131 days). Fourteen of 19 (74%) dogs that started treatment with multi-modal immunosuppression and 32 of 54 (59%) started on corticosteroids alone achieved a complete cure.
CLINICAL SIGNIFICANCE
This study provides extended follow-up information for a large cohort of dogs with primary immune-mediated polyarthritis. Immunosuppressive therapy was discontinued in the majority of dogs but disease-associated mortality remains high.
Topics: Dogs; Animals; Retrospective Studies; Immunosuppressive Agents; Adrenal Cortex Hormones; Arthritis; Recurrence; Dog Diseases
PubMed: 36321528
DOI: 10.1111/jsap.13565