Rheumatology – Polyarticular Pain: By Lori Albert M.D.

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Rheumatology – Polyarticular Pain
Whiteboard Animation Transcript
with Lori Albert, MD
https://medskl.com/Module/Index/polya...

Polyarticular pain is common and can be due to a common problem, like osteoarthritis. However, there are some patients with polyarticular pain who have inflammatory polyarthritis, and may have a serious condition that you cannot afford to miss.

Here are four causes of polyarticular pain you cannot afford to miss.

1. Rheumatoid arthritis

This relatively common form of inflammatory arthritis most commonly presents with subacute onset of painful and swollen joints. These patients develop prolonged morning stiffness and impairment of function. The examination reveals swelling and tenderness symmetrically in small joints of the hands, wrist, elbows, knees and feet. The DIP joints and lumbar spine are spared. These patients need to be assessed by a rheumatologist for early treatment to prevent joint damage and restore function.

2. Lupus and collagen vascular diseases

Patients with these conditions often have arthritis that looks similar to rheumatoid arthritis. However, these patients may have more significant constitutional symptoms (fatigue, weight loss, sweats) and they also have other “extra-articular manifestations.” These manifestations can include rashes, hair loss, photosensitivity, dry eyes/dry mouth, Raynaud’s phenomenon (cold-induced blanching of the fingers), and others.

Laboratory evaluation is very important in these patients to look for cytopenias and renal involvement, which can be very serious and even life threatening. These patients need rapid referral to a rheumatologist.

3. Vasculitis

Certain forms of small vessel vasculitis can sometimes present with inflammatory arthritis. These patients may also be more systemically unwell, and may quickly develop serious involvement of kidney (glomerulonephritis) and/or lungs (pulmonary hemorrhage). If you see a patient with inflammatory arthritis and progressive anemia or rising creatinine (that is not due to medication), this patient needs an urgent referral to a rheumatologist.

4. Infectious Polyarthritis

Polyarthralgia is common with viral infections and is usually self-limited. However, think about polyarthritis associated with bacterial endocarditis in a patient who is systemically unwell, has fevers, embolic phenomenon, and a loud cardiac murmur. Think about infection with Neisseria gonorrhoeae in the young, sexually active patient with acute, migratory polyarthritis/polyarthralgia and scattered hemorrhagic pustules and vesicles. It is important to recognize patients with infections, as the treatment is specific to the infection and does NOT require therapy with immunomodulators.

So, in the patient presenting with polyarticular pain, a careful history and complete examination will help you to avoid missing potentially serious diagnoses!