Peripheral joints VS axial joints In the context of juvenile idiopathic arthritis (JIA), oligoarthritis is defined as arthritis involving fewer than five joints, whereas polyarthritis is arthritis of five or more joints. The arthritis of gonococcal disease occurs as an acute migratory polyarthritis with tenosynovitis, often involving the hands. The differential diagnosis is broad and includes infectious causes, crystal induced arthropathy, rheumatoid arthritis, vasculitic syndromes, connective tissue disorders, and spondyloarthridies 6. Migratory arthritis is characterized by pain and swelling in one or two joints. arthritis in 2 to 3 joints1. Polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. Common causes include inflammatory arthritis including crystal arthropathy and other forms of systemic rheumatic disease such as connective tissue disorders and occasionally infectious agents [ 4 ]. Lyme disease diers as inammation of the hand is not commonly seen.3 Early Lyme often causes a migratory arthralgia, later progressing to arthritis of mainly large joints.8 In one study, 51 percent of patients developed arthritis weeks to months after being diagnosed with Lyme disease. Rat bite fever is a rare, underdiagnosed disease caused by Streptobacillus moniliformis in the United States, and is typically characterized by leukocytosis, elevated C-reactive protein, migratory polyarthralgias, and pustular skin rash. Lyme disease, discussed above, is most commonly monoarticular but can present in a polyarticular fashion. PDF Joint Pain in Children: Initial Evaluation and When to Refer Arthritis Eosinophilic granulomatosis with polyangiitis (Churg Strauss) C1 esterase deficiency Hematologic malignancy Drug-related2 Travel to endemic region N N N N N N Eosinophilia Y1 NN NY Y1 Migratory skin lesions / angioedema Y Y Y Y Y Y Fever Y Y Y N Y Y Arthritis/arthralgia Y Y Y N Y N Proteinuria Y NY N Y N Rash (urticarial) Y Y N Y Y Y What Is Migratory Arthritis? (with pictures) Identifying these lesions and ruling out other possible causes is crucial to carry out a correct differential diagnosis . Onset can be gradual or sudden. In this article, the first in a series of two articles on arthritis, a clinical approach to . It typically leads to deformity through the stretching of tendons and ligaments and destruction of joints through the erosion of cartilage and bone. Reactive arthritis can also be triggered by a sexually transmitted disease, referred to as sexually acquired reactive arthritis. Migratory arthritis is characterized by rapid onset of swelling in one or two joints. 1968 Jun. 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. Arthritis Rheum. Another feature of gonococcal infection includes small, painless, maculopapular, pustular, or vesicular lesions on an erythematous base involving the extremities. Lyme disease, Chlamydia) reactive arthritis, palindromic rheumatoid arthritis, crystal induced arthropathy, as well as autoimmune diseases. migratory polyarthritis, and carditis would argue against this . Lyme disease. The first step is to distinguish between true articular pain and nonarticular or periarticular . Reactive arthritis, occurring after enteric or urogenital infections, is also a possibility. Several different diseases ranging from rheumatoid arthritis to infection diseases can lead to polyarthritis. A 31-year-old male patient with severe, migratory arthralgias presented to our academic medical centre after being erroneously diagnosed and treated for rheumatoid arthritis for over 1 year. with psoriatic arthritis, gout, pseudogout, and sarcoid. Identifying the cause of polyarticular joint pain can be difficult because of the extensive differential diagnosis. Anamnesis, physical examination, laboratory findings and imaging methods are important tools to differential diagnosis. Other differential diagnoses include crystal arthritis (gout, calcium pyrophosphate deposition disease), reactive arthritis or other seronegative spondyloarthritides, sarcoidosis, familial Mediterranean fever and Behçet's disease. If single joints are involved for more than a few days or weeks, other possible causes of arthritis, such as the systemic form of . This condition is an orderly involvement of primarily intermediate joints, approximately one per day, characterized by periarticular swelling. The differential diagnosis of this disease includes clearly distinguishing its symptoms from the signs of similar disorders, such as: Rheumatoid arthritis; Gout; Reactive arthritis; Polyarthritis Treatment. Having arthritis certainly increases your risk for migrating joint pain, but that doesn't mean it's the only cause of migratory arthritis. It can affect people in any age group, including children. Unfortunately, many doctors come to the diagnosis of migratory arthritis by ruling out all other forms of inflammatory joint pain. People who suffer from the regular form of this inflammatory disease usually have pain in both wrists or knees at the same time when a flare . When questioned, the patient recalled a rat bite 3 days before symptom onset. Jennifer Mackin Migratory arthritis causes symptoms to move throughout the body, rather than remain constant in one area. Khachadurian AK. The arthritis of gonococcal disease occurs as an acute migratory polyarthritis with tenosynovitis, often involving the hands. By morning it is always gone. • Lax joint capsules, tendons, ligaments = reducible deformity. Arthritis is a term often used to mean any disorder that affects joints. Migratory arthritis often is very painful but responsive to NSAIDs. • Up to 95% of SLE patients have arthritis. Keeping track of any symptoms that are occurring, along with what makes them better and . It may also arise in adults when it tends to persist. Inflammatory Joint Pain - Differential Diagnosis Algorithm Monoarticular • Gout (Podagra, Tophi) • Pseudogout • Early Rheumatic Disease • Reactive (e.g. 49 years experience Orthopedic Surgery. We present a case of a 12-year-old girl who presented with migratory arthritis, chorea and ascites. 6,44 Polyarthritis is non-suppurative, asymmetrical, migratory, and self-limited, and does not result in permanent deformity. Based on this history, pustule fluid and blood were submitted for culture. Here we describe an alternative strategy of defining T cell subpopulations in blood and synovial fluid based on differential expression of integrins and other migratory receptors that help cells localize to specific target tissues. Malignancy (metastases, osteochondroma, osteoid osteoma) Reactive poststreptococcal arthritis. Migratory arthritis or polyarthritis is a type of arthritis where symptoms shift from one joint to another. 70(4):891-4. . Founded in 1998, the Arthritis Center at Johns Hopkins is dedicated to providing quality education to patients and healthcare providers alike. The etiology is unknown, and the genetic component is complex, making clear distinctions between the various subtypes difficult. When questioned, the patient recalled a rat bite 3 days before symptom onset. The key to the correct diagnosis was symptoms of persistent fever, migratory polyarthralgias, and purpuric rash extending to the palms and soles. The symptoms don't seem to stay in one joint for very long. The differential diagnosis is broad and includes infectious causes, crystal induced arthropathy, rheumatoid arthritis, vasculitic syndromes, connective tissue disorders, and spondyloarthridies 6. Migratory arthritis is an uncommon condition where arthritis symptoms travel from one joint to another. The most common underlying disorder is rheumatoid arthritis (30 to 60% of cases). Differential diagnosis, Diagnosis, Rheumatoid arthritis, CKS. A thorough history and a complete physical examination are essential. Lesions may affect trunk and limbs, and less often scalp and face. Rheumatic fever due to strep infections is classically the disease that causes a true migratory arthritis, but this is very rare in the modern day of antibiotics. Symptoms generally include joint pain and stiffness. Inflammatory Bowel Disease) • Reactive • Rheumatic Fever (recent Pharyngitis, Carditis) • Lyme Disease . Reactive arthritis is defined as a sterile inflammation involving the synovial membrane, tendons and/or fascia, elicited by an infection, usually originating from gastrointestinal or genitourinary tracts. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. It can be frustrating . This is a diagnosis of exclusion, so other causes of arthritis must be ruled out. The differential diagnosis includes infectious causes (e.g. Peripheral oligoarticular arthritis and polyarticular arthritis are more commonly associated with a systemic infection (eg, viral) or systemic inflammatory disorder (eg, rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily involves the joints. Algorithm for Monoarticular arthralgia. A migratory arthritis may occur, and some patients have symmetric polyarthritis suggestive of rheumatoid arthritis. It is frequently suspected and diagnosed by the incidental finding of characteristic bone lesions on plain radiographs requested for another reason. Crystal-induced ( Gout, Pseudogout) Gonococcal arthritis, arthritis-dermatitis syndrome. arthritis翻譯：關節炎。了解更多。 Compared to patients with depression, rheumatoid arthritis and heart disease, the study participants were markedly impaired in both the physical and psychological domains. It is usually observed in people suffering from gonorrhea. Wrist, thumb, knee, foot, shoulder, elbow. Although there is a broad differential diagnosis, a thorough history and physical examination should provide sufficient information to direct the evaluation . psoriatic arthritis, dissiminated gonococcal arthritis (DGI) - อาการเด่นที่ขอ้ขา (predominate lower limbs) เช่น spondyloarthropathy, septic arthritis, osteoarthritis, avascular necrosis, crystal induced arthritis (gout/pseudogout) 3. Simply put, migratory arthritis describes the condition when arthritis symptoms (e.g., pain, swelling, warmth, redness, and stiffness in or around a joint) travel from one joint to another joint. Acute monoarthritis can be the initial manifestation of many joint disorders 2). Migratory arthritis among children typically is described in acute rheumatic fever. • Non-erosive, migratory, may resolve in a given joint in <24h. Symptoms can include pain, swelling, redness, . synovial fluid cultures could be negative even in the face of gonococcal arthritis. The differential diagnosis includes infectious, rheumatic, and neoplastic etiologies. The arthritis of gonococcal disease occurs as an acute migratory polyarthritis with tenosynovitis, often involving the hands. Osteopokilosis is a rare benign bone dysplasia that may result in musculoskeletal pain, although it is usually asymptomatic. She was diagnosed to have systemic lupus erythematosus (SLE) and subsequently responded to immunosuppressive therapy. The etiology is unknown, and the genetic component is complex, making clear distinctions between the various subtypes difficult. Urticaria pigmentosa is a form of cutaneous mastocytosis in which there are brown macules and papules. This kind of arthritis usually affects the larger joints and begins in an order starting from ankle, knee, wrist, elbow, shoulder and hip.
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