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ACUTE MONOARTHRITIS
BERGER’S B’S
• BUGS
• BLOOD
• BIREFRIGENCE
CALCIUM
PYROPHOSPHATE (cppd)
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Acute pseudogout
Female predominant
Knees/Shoulders/Wrists/MCP’s
High fever and sed rate possible
Can coexist in same joint with true
infectious etiology: Unlike gout
CALCIUM HYDROXYAPATITE
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“Milwaukee Shoulder”
Shoulders/knees/hips
Hemarthrosis associated
Rotator cuff destruction
Fever and high sed rate less
common than in CPPD
Musculoskeletal Presentations of
Infectious Diseases
• Known systemic infectious
diseases with musculoskeletal
presentations
• Probable infectious agent causing
systemic rheumatic disease
Post Streptococcal Arthritis
(Rheumatic Fever)
• Shoulder “periarthritis” (80% in
Persellin series in 1970’s)
• Classical migratory large joint
synovitis rare
• Nodules/Carditis/Athetosis rare
• E nodosum more common than E
marginatum
Gonorrhea
• Monoarticular/Pauciarticular
synovitis: Large joint
predominance
• Recovery of organism from joint
10% or less. Smears negative
• When recovered from joint, Rx the
same as Staph septic joint:
Recurrent aspirations
KAWASAKI DISEASE
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Fever lasting at least 5 days
Bilateral conjunctivitis
Oral mucous membrane changes
Peripheral extremity changes
Polymorphus rash
Cervical lymphadenopathy
Lab markers of inflammation
KAWASAKI DISEASE
• Inflammatory Arthritis: 15-25 %
• Diarrhea/Abd pain: 50%
• Cough: 35 %
• CORONARY ARTERITIS WITH
ANEURYSMS: ? 100% ACUTELY
• IVIG AND ASA!!!
Parvovirus: B19
• Rheumatoid Arthritis look alike:
Symmetrical Polyarthritis
involving hands/wrists/knees/feet
• + RF and ANA 20-30%
• + cryoglobulins
• 6 month course
• Steroids occasionally required
HEPATITIS B
• Symmetrical polyarthritis:small
joints
• Sometimes Urticarial rash
• Prodrome to jaundice
• Low serum complements
• Sometimes with
glomerulonephritis
RUBELLA
• Large joint oligoarthropathy almost
always involving knees
• Can last months
• Chronic RA look alike described
after initial infection
• Can occur after immunizations
LYME DISEASE
• True arthritis tertiary manifestation
– Arthralgia common in secondary stage
• Pauciarticular large joint arthopathy
• Thought intially to be JRA
– One mother and local PTA + YALE
REACTIVE ARTHRITIS
SYNDROME
• 90% with preceding chlamydial
infection vs. bowel pathogen
– Also described after Chlamydia
Pneumonia and Mycoplasma Pneumonia
• Chlamydial antigen demonstrated
in synovium in involved joints
– ?? Controls
– ?? Immunological mechanism
LOFGRENS SYNDROME
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Acute Histoplasmosis/Sarcoidosis
Fever
Erythema Nodosum
Ankle Periarthritis
Hilar Adenopathy
Occasional uveitis/parotitis
Usually resolves without sequelae
GIANT CELL ARTERITIS
• Temporal /Takayasu’s arteritis
– Old Scandinavian women vs. young
Japanese/Israeli/Mexican women
– Carotid vs. aortic arch circulation
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Systemic symptoms: FUO presentation
Symmetrical polyarthritis: 10%
Sed rates!!!!!!!!
Parvovirus anectdotes: Mayo data
BEHCET’S SYNDROME
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Painful oral and genital ulcers
Uveitis: Anterior and posterior
“Pathergic” skin rash
Aseptic meningitis
Hypercoaguability
Pulmonary arterial aneurysms
TNF excess: Therapeutic options
Relapsing Polychondritis
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True cause of ER Dx of costochondritis
Chondritis/scleritis/vasculitis
Fever and arthritis
Palpable purpura
Subglottic stenosis
Tracheal collapse
Rx with steroids and immunosuppresion