Table of contents
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Differential Diagnosis
Monoarthritis
- Workup of Chronic Inflammatory Monoarthritis
- Gonococcal History?
- Joint Aspirate - gram stain, bacterial culture, polarized light microscopy.
- Lyme Disease Titres, Rheumatoid Factor, Anti-CCP antibodies, TB skin test.
- If fungal arthritis is suspected: Synovial biopsy or fungal culture of fluid (Culture takes many weeks).
- Infection
- Septic Arthritis (Staph, gonococcal, fungi, TB)
- Crystal
- Gout
- Pseudogout
- Hydroxyapatite
- Trauma
- Hemarthrosis
- Osteonecrosis
- Degenerative
- Osteoarthritis
- Neoplastic
- Tumor
- Systemic Inflammatory
Oligo/Polyarthritis
- Acute (<6 wks)
- First presentation inflammatory arthritis
- Post-viral (pavroviris B19)
- Acute rheumatic fever
- Infectious (GC vs. Non-GC)
- Chronic (> 6 wks)
- Seropositive
- Rheumatoid Arthritis
- SLE
- Scleroderma
- Polymyositis/Dermatomyositis
- Seronegative
- Ankylosing Spondylitis
- Enteropathic Arthritis
- Psoriatic Arthritis
- Reactive Arthritis
- Crystal (Polyarticular gout)
- Degenerative
- Osteoarthritis
- Seropositive
Important NOTES
- Rule out mechanical symptoms that would require ortho evaluation +/- MRI:
- Catching
- Locking
- Giving way
Disease Severity Index
- Many diseases have their own (i.e. DAS28 for RA, SLAM for SLE, etc..)
- HAQ is a global one that is useful.
- HAQ - Health Assessment Questionaire
- Purely functional, patients fill out. (walking, grooming, etc..)
- Measure of disease activity AND damage
- Prognostic
- Short Version of HAQ: multidimensional HAQ, Rapid 3, etc... (many useful + practical)
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