Polyarticular joint pain profoma

Question 1

Presentation of polyarticular joint pain?

Answer 1

Hallmarks of ALL inflammatory arthritis (e.g. RA, Reactive, ankylosing spondylitis):

• Pain or swelling affecting 5 or more joints
• Early-morning stiffness
• Tenderness
• Better w/ activity
• Extra-articular features e.g. uveitis, dactylitis, nail pitting, psoriasis, nodules, conjunctivitis, urethritis…

Question 2

Investigations for polyarticular joint pain

Answer 2

Blood tests:
- ESR/ CRP
- Anti-CCP
- Serum urate
- Serum calcium
- Viral serology
- FBC

Imaging:
- X-ray
- CT
- Ultrasound or MRI- for synovitis

Question 3

Key differential diagnosis for polyarticular joint pain?

Answer 3

RA:
- Symmetrical
- Small & large joints

Reactive arthritis:
- Asymmetrical
- Oligoarticular (2-4 joints)
- often caused by UTI or STI

OA:
- Symmetrical
- PIP, DIP, hips, knees, back
- associated w/ Herberden’s & Bouchard’s nodes

Psoriatic arthritis:
- Asymetrical
- targets all joints & enthuses
- Associated w/ nail pitting & dactylics

Ankylosing spondylitis:
- Affect midsize & large joints & entheses
- History of inflammatory back pain (sacroillitis)
- Large joints in asymmetrical pattern

Systemic lupus erythematosus:
- Symmetrical
- typically affects small joints
- synovitis unusal
- causes polyarthralgia & tenosynovitis (inflammation of tendon & its synovial sheath )

Juvenile idiopathic arthritis:
- Polyarticular
- Oligoarticular
-Systemic but also enthesitis-predominant

Chronic gout:
- Affects distal more than proximal joints
- history of acute attacks

Pseudgout:
- Chronic poly arthritis w/ involvement of wrists, ankles, knees
- Oligoarticular small hand joints

NOTE: VIEW notes for DISTRIBUTION diagram of conditions

Question 4

Initial management of polyarticular pain

Answer 4

• NSAIDs + PPI (unless contraindicated!!)
• Systemic glucocorticoids if very severe pain
• Refer to secondary care