Деякі причини болю в ≥ 5 суглобах*
Cause | Suggestive Findings | Diagnosis† |
|---|---|---|
Severe, migratory pain affecting mainly the large joints in the legs, elbows, and wrists Tenderness more severe than swelling Extra-articular manifestations, such as fever, symptoms and signs of cardiac dysfunction, chorea, subcutaneous nodules, and rash Prior streptococcal pharyngitis | Specific (Jones) clinical criteria Tests for Group A streptococcal infection (eg, culture, rapid strep test, antistreptolysin O and anti-DNase B titers) ECG and echocardiogram | |
Hemoglobinopathies (eg, sickle cell disease or trait, thalassemias) | Pain usually near but sometimes in joints, sometimes symmetric Usually in children or young patients of African or Mediterranean descent, often with known diagnosis | Hemoglobin electrophoresis |
Hypermobility syndromes (eg, Ehlers-Danlos, Marfan, benign hypermobility) | Polyarthralgia, rarely with arthritis Recurrent joint subluxation Sometimes increased skin laxity Usually family history of joint hypermobility For Marfan and Ehlers-Danlos syndromes, possibly a family history of aortic aneurysm or dissection at a young age or during middle age | Clinical evaluation Sometimes genetic testing (no gene test is available for hypermobile Ehlers-Danlos) |
Infectious bacterial (septic) arthritis (more commonly monoarticular) | Acute arthritis with severe pain and joint effusions Sometimes immunosuppression or risk factors for STIs | Arthrocentesis |
Infectious viral arthritis (parvovirus B19, hepatitis B, hepatitis C, enterovirus, rubella, mumps, and HIV) | Acute arthritis Joint pain and swelling usually less severe than infectious bacterial arthritis Other systemic symptoms depending on virus (eg, jaundice with hepatitis B, often generalized lymphadenopathy with HIV) | Viral serology testing as clinically indicated (eg, hepatitis B surface antigen and IgM antibody to hepatitis B core for suspected hepatitis B) |
Childhood onset of joint symptoms Manifestation with oligoarthritis plus uveitis, or with systemic symptoms (Still disease—fever, rash, adenopathy, splenomegaly, pleural and/or pericardial effusions) | Clinical evaluation Antinuclear antibodies, rheumatoid factor, and HLA-B27 testing | |
Other rheumatic diseases (eg, Sjögren syndrome, autoimmune myositis, polymyalgia rheumatica, systemic sclerosis [scleroderma]) | Disease-specific manifestations including specific dermatologic manifestations (dermatomyositis), dysphagia, severe Raynaud syndrome or sclerodactyly (systemic sclerosis), muscle soreness (polymyalgia rheumatica), or dry eyes and dry mouth (Sjögren syndrome) | Clinical evaluation Sometimes x-rays and/or serologic testing (eg, anti-SSA and anti-SSB in Sjögren syndrome, anti-Scl-70 in systemic sclerosis) Sometimes skin or muscle biopsy |
One of five patterns of joint involvement, which include polyarthritis similar to rheumatoid arthritis and oligoarthritis Extra-articular manifestations, such as psoriasis, onychodystrophy, uveitis, tendinitis, and dactylitis (sausage digits) | Clinical evaluation X-rays | |
Symmetric arthritis of small and large joints Rarely initially monoarticular or oligoarticular More common among young adults but can manifest at any age Sometimes joint deformities at late stages | Clinical evaluation Rheumatoid factor and anti-cyclic citrullinated peptide testing X-rays | |
Serum sickness | Arthralgia more often than arthritis Fever, lymphadenopathy, and rash Exposure to blood products within 21 days of symptom onset | Clinical evaluation |
Arthralgia more often than arthritis Jaccoud arthropathy Systemic manifestations, such as rash (eg, malar rash), mucosal lesions (eg, oral ulcers), serositis (eg, pleuritis, pericarditis), manifestations of glomerulonephritis More common among women | Clinical evaluation Antinuclear antibodies, anti-dsDNA, complete blood count (leukopenia or thrombocytopenia), urinalysis, chemistry profile with creatinine and liver enzymes | |
Systemic vasculitides (eg, immunoglobulin A–associated vasculitis [formerly called Henoch-Schönlein purpura], polyarteritis nodosa, granulomatosis with polyangiitis) | Arthralgia more often than arthritis Extra-articular symptoms, often involving multiple organ systems (eg, abdominal pain, renal failure, manifestations of pneumonitis, sinonasal symptoms, skin lesions that may include rash, purpura, nodules, and ulcers) | Serologic testing as clinically indicated (eg, antineutrophil cytoplasmic antibodies testing with suspected granulomatosis with polyangiitis) Biopsy as indicated (eg, of kidney, skin, or lung) |
* These disorders may also manifest as oligoarticular (involving ≤ 4 joints). | ||
† Patients with joint effusion or inflammation should have arthrocentesis (with cell counts, Gram stain, cultures, and crystal examination), and usually erythrocyte sedimentation rate (ESR) and C-reactive protein. X-rays are often unnecessary. | ||
dsDNA = double-stranded DNA. | ||