Polyarthritis
Quick Tips to Diagnosis

Family physicians frequently find themselves presented with a patient complaining of symptoms of Polyarthritis. The differential diagnosis is large, but the following tips may help. These are the possibilities a Rheumatologist will consider when seeing a similar patient.

Rheumatoid arthritis - suspect if: female, 35-55 years of age, symmetric polyarthritis effecting PIPs, MCPs, Wrists, Ankles and MTPs, olecranon nodules, morning stiffness >1hour, or night pain.

Systemic Lupus erythematosus - suspect if: female, 15-35 years of age, butterfly facial erythema, mouth ulcers, pleuropericardial pain, polyarthritis, positive ANA, or less commonly, fever.

Psoriatic arthritis - suspect if: Asymmetrical Oligo or polyarthritis, DIP's involvement, dactylitis of fingers or toes, psoriasis (maybe hidden), nail lesions, low back pain, morning stiffness.

Polymyalgia rheumatica - suspect if: > 50 years of age, systemic symptoms such as fatigue, weight loss, severe morning stiffness (Have to roll out of bed), pain and stiffness of shoulder and pelvic girdle, rapid response to steroids.

Connective tissue disease - suspect if: Polyarthritis or polyarthralgia, age < 40, female gender, systemic malaise, Raynaud's phenomenon, skin rash, dry eyes or mouth, digital ulcers, sclerodactyly, proximal muscle weakness, positive ANA. (De novo multisystem complaints in a young female)

Viral Arthritis - suspect if: adolescent or young adult, fever, adenopathy, infectious contact or vaccination, exanthematous rash.

Viral hepatitis polyarthritis - suspect if: acute onset, symmetrical, small and large joints, polyarthritis, urticaria, macular rash, erythematous tender skin nodules.

Serum sickness - suspect if: low grade fever, urticaria, lymphadenopathy, large and medium size joints, drug exposure (e.g. sulfa, penicillin).

Inflammatory Bowel Disease arthritis - suspect if: Preceding or synchronous gastrointestinal symptoms, oligo or polyarthritis of lower limb, spondylitis, erythema nodosum.

Reiter's syndrome - suspect if: Male, large joint arthritis, urethritis, conjunctivitis, painless mouth ulcers, circinate balanitis, cutaneous lesions of palms and soles (Keratoderma blenorragicum), nail changes similar to psoriasis. History of Chlamydia infection, bloody diarrhea, food poisoning.

Adult onset Still's disease - suspect if: Spiking quotidian fever, polyarthritis, salmon coloured macular or maculopapular rash, fatigue, malaise, weight loss and myalgia.

Lyme Disease - suspect if: Endemic area for deer ticks, erythema chronicum migrans, history of neurologic symptoms such as Bell's palsy, cardiac arrhythmia, tendinitis, bursitis followed by asymmetric large joint arthritis.

- Denis Choquette