ACUTE MONOARTHRITIS BERGER’S B’S
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ACUTE MONOARTHRITISBERGER’S B’S
• BUGS
• BLOOD
• BIREFRIGENCE
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CALCIUM PYROPHOSPHATE (cppd)
• 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
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CALCIUM HYDROXYAPATITE
• “Milwaukee Shoulder”
• Shoulders/knees/hips
• Hemarthrosis associated
• Rotator cuff destruction
• Fever and high sed rate less common than in CPPD
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Musculoskeletal Presentations of Infectious Diseases
• Known systemic infectious diseases with musculoskeletal presentations
• Probable infectious agent causing systemic rheumatic disease
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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
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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
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KAWASAKI DISEASE
• Fever lasting at least 5 days
• Bilateral conjunctivitis
• Oral mucous membrane changes
• Peripheral extremity changes
• Polymorphus rash
• Cervical lymphadenopathy
• Lab markers of inflammation
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KAWASAKI DISEASE
• Inflammatory Arthritis: 15-25 %
• Diarrhea/Abd pain: 50%
• Cough: 35 %
• CORONARY ARTERITIS WITH ANEURYSMS: ? 100% ACUTELY
• IVIG AND ASA!!!
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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
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HEPATITIS B• Symmetrical polyarthritis:small
joints
• Sometimes Urticarial rash
• Prodrome to jaundice
• Low serum complements
• Sometimes with glomerulonephritis
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RUBELLA
• Large joint oligoarthropathy almost always involving knees
• Can last months
• Chronic RA look alike described after initial infection
• Can occur after immunizations
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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
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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
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LOFGRENS SYNDROME
• Acute Histoplasmosis/Sarcoidosis
• Fever
• Erythema Nodosum
• Ankle Periarthritis
• Hilar Adenopathy
• Occasional uveitis/parotitis
• Usually resolves without sequelae
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GIANT CELL ARTERITIS
• Temporal /Takayasu’s arteritis– Old Scandinavian women vs. young
Japanese/Israeli/Mexican women
– Carotid vs. aortic arch circulation
• Systemic symptoms: FUO presentation
• Symmetrical polyarthritis: 10%
• Sed rates!!!!!!!!
• Parvovirus anectdotes: Mayo data
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BEHCET’S SYNDROME
• Painful oral and genital ulcers
• Uveitis: Anterior and posterior
• “Pathergic” skin rash
• Aseptic meningitis
• Hypercoaguability
• Pulmonary arterial aneurysms
• TNF excess: Therapeutic options
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Relapsing Polychondritis
• True cause of ER Dx of costochondritis
• Chondritis/scleritis/vasculitis
• Fever and arthritis
• Palpable purpura
• Subglottic stenosis
• Tracheal collapse
• Rx with steroids and immunosuppresion
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