Approach To Arthritis

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    Diagram

    • ArthritisApproach.png

    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

    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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