Polyarticular Arthritis

Aka: Polyarticular Arthritis, Polyarticular Joint Pain, Polyarthritis, Pauciarticular Arthritis, Oligoarticular Arthritis, Migratory Arthritis, Migratory polyarthritis, Oligoarticular, Oligoarthritis, Pauciarticular, Polyarticular

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II. Causes: General

  1. Viral Infection
    1. Parvovirus B19
    2. Epstein-Barr Virus
    3. Varicella Zoster
    4. Enterovirus, Adenovirus or Coxsackievirus
    5. Hepatitis B Virus
    6. Human Immunodeficiency Virus (HIV)
    7. Mumps
    8. Rubella
  2. Bacterial Infection
    1. Gonococcal Arthritis
    2. Bacterial Endocarditis
    3. Rheumatic Fever
    4. Whipple's Disease
    5. Salmonella, Shigella or Yersinia Infection
    6. Staphylococcus aureus
    7. Tuberculosis
    8. Lyme Disease
    9. Syphilis
  3. Systemic conditions
    1. Rheumatoid Arthritis
    2. Osteoarthritis
    3. Fibromyalgia
    4. Systemic Lupus Erythematosus
    5. Polymyositis
    6. Polymyalgia Rheumatica
    7. Sarcoidosis
    8. Scleroderma
    9. Sjogren's Syndrome
    10. Behcet's Syndrome
    11. Henoch-Schonlein Purpura
    12. Polyarteritis Nodosa
    13. Granulomatosis with Polyangiitis (previously known as Wegener's Granulomatosis)
    14. Hyperthyroidism
    15. Hypothyroidism
    16. Hyperparathyroidism
  4. Miscellaneous
    1. Cancer (Multiple Myeloma, Metastatic Cancer)
    2. Crystal-induced (e.g. Gout, Pseudogout)
    3. Ankylosing Spondylitis
    4. Psoriatic Arthritis
    5. Inflammatory Bowel Disease
    6. Reiter's Syndrome

III. Causes: By Number of Joints Involved

  1. Pauciarticular (Oligoarticular) (2-4 joints)
    1. Spondyloarthropathy (especially sacroiliac)
    2. Sarcoidosis (especially ankle)
    3. Rheumatoid Arthritis
    4. Psoriatic Arthritis
    5. Gonococcal Arthritis
  2. Polyarticular (Common)
    1. Large joints
      1. Ankylosing Spondylitis
    2. Small joints
      1. Parvovirus B19
      2. Systemic Lupus Erythematosus
    3. Large and small joints
      1. Osteoarthritis
      2. Rheumatoid Arthritis
      3. Psoriatic Arthritis
  3. Migratory Arthritis
    1. Gonococcal Arthritis
    2. Rheumatic Fever
    3. Sarcoidosis
    4. Systemic Lupus Erythematosus
    5. Lyme Disease
    6. Bacterial Endocarditis
    7. Whipple's Disease

IV. Causes: By Symmetry

  1. Symmetric Polyarthritis
    1. Rheumatoid Arthritis
    2. Systemic Lupus Erythematosus
    3. Psoriatic Arthritis
    4. Osteoarthritis
    5. Scleroderma
    6. Lyme Disease
    7. Rheumatic Fever
    8. Gouty Arthritis
    9. Pseudogout
    10. Liver Disease
  2. Asymmetric Polyarthritis
    1. Spondyloarthropathy (HLA-B27 Disease)
      1. Psoriatic Arthritis
      2. Ankylosing Spondylitis
      3. Reactive Arthritis
      4. Inflammatory Bowel Disease
    2. Gouty Arthritis
    3. Pseudogout
    4. Lyme Disease
    5. Viral Arthritis

V. Causes: Inflammatory Arthritis By Timing

  1. Acute Inflammatory Polyarthritis (synovitis <6 weeks)
    1. Bacterial Infections (see full list of Bacterial causes as above)
      1. Gonococcal Arthritis
      2. Infectious Endocarditis
      3. Lyme Disease
      4. Meningitis
      5. Rheumatic Fever
    2. Viral Arthritis (see full list of viral causes as above)
      1. Acute HIV Infection (Acute Retroviral Syndrome)
      2. Parvovirus B19
      3. Viral Hepatitis
    3. Crystal Arthropathy
      1. Gout
      2. Pseudogout
    4. New onset rheumatic disease
      1. See rheumatic diseases as below
  2. Chronic Inflammatory Polyarthritis (synovitis >6 weeks)
    1. Crystal Arthropathy
      1. Gout
      2. Pseudogout
    2. Rheumatic Disease
      1. Arthropathy of Inflammatory Bowel Disease
      2. Polymyalgia Rheumatica
      3. Psoriatic Arthritis
      4. Reactive Arthritis
      5. Rheumatoid Arthritis
      6. Sarcoidosis
      7. Systemic Lupus Erythematosus
      8. Spondyloarthropathy
      9. Systemic Sclerosis

VI. Causes: By Region

  1. Shoulder Associated Rheumatologic Conditions
    1. Shoulder Osteoarthritis
    2. Rheumatoid Arthritis
    3. Arthropathy of Inflammatory Bowel Disease
    4. Polymyalgia Rheumatica (Shoulder girdle region)
    5. Pseudogout
    6. Systemic Lupus Erythematosus
  2. Elbow associated Rheumatologic Conditions
    1. Rheumatoid Arthritis
    2. Arthropathy of Inflammatory Bowel Disease
    3. Polyarticular Gouty Arthritis
    4. Pseudogout
  3. Hand Associated Rheumatologic Conditions (includes wrist)
    1. Hand Osteoarthritis (DIP and PIP nodes, first MCP, thumb trapeziometacarpal joint)
    2. Rheumatoid Arthritis (PIP, MCP and wrist)
    3. Psoriatic Arthritis (any hand joint but esp. DIP, Sausage Digits, Nail Pitting)
    4. Hemochromatosis (second and third MCP)
    5. Polyarticular Gouty Arthritis (PIP, DIP joints, tophi)
    6. Pseudogout (wrist)
    7. Gonococcal Arthritis
    8. Systemic Sclerosis and Scleroderma (Sausage Digits, distal Cyanosis, calcified Nodules)
  4. Cervical Spine Associated Rheumatologic Conditions
    1. Osteoarthritis
    2. Rheumatoid Arthritis
    3. Psoriatic Arthritis
    4. Pseudogout
    5. Reactive Arthritis
  5. Low Back Associated Rheumatologic Conditions
    1. Spondyloarthropathy
    2. Osteoarthritis
  6. Hip Associated Rheumatologic Conditions
    1. Osteoarthritis
    2. Rheumatoid Arthritis
    3. Hip Avascular Necrosis
    4. Psoriatic Arthritis
    5. Arthropathy of Inflammatory Bowel Disease
    6. Pseuodgout
  7. Knee Associated Rheumatologic Conditions
    1. Knee Osteoarthritis
    2. Rheumatoid Arthritis
    3. Pseuodgout
    4. Polyarticular Gouty Arthritis
  8. Foot Associated Rheumatologic Conditions
    1. Osteoarthritis (first MTP)
    2. Rheumatoid Arthritis (MTP, ankles)
    3. Psoriatic Arthritis (Sausage Digits, Nail Pitting, ankles)
    4. Reactive Arthritis
    5. Gouty Arthritis (first MTP)
    6. Pseudogout (ankle)

VII. Evaluation

  1. See Joint Pain for History, Exam, Labs and Imaging

VIII. References

  1. Foster (2023) Am Fam Physician 107(1): 42-51 [PubMed]
  2. Klinkhoff (2000) CMAJ 162:1833-8 [PubMed]
  3. Pujalte (2015) Am Fam Physician 92(1):35-41 [PubMed]
  4. Richie (2003) Am Fam Physician 68(6):1151-60 [PubMed]

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