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Patterns of Arthropathy

 
 
 
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Overview

The pattern of joint involvement in arthritis can be used clinically to identify the most likely pathology.
Arthritis may affect one joint or multiple joints in a symmetric or asymmetric pattern.

Monoarthritis

Monoarthritis is the inflammation of a single joint. This is commonly due to trauma, gout, or infection.
Monoarthritis may also be the first manifestation of a polyarthritis, such as rheumatoid arthritis, seronegative spondyloarthropathy or connective tissue disease.
  • Causes of Monoarthritis

  • Trauma - fracture, soft tissue injury
  • Crystal arthropathies - gout, pseudogout
  • Septic arthritis - gonococcal, Staph, Strep, gram negative
  • Osteoarthritis
  • Haemarthrosis (traumatic or in the setting of coagulopathy)
  • Malignancy - sarcoma, metastasis
  • Avascular necrosis
  • Tendonitis
  • Bursitis

Polyarthritis

Polyarthritis refers to inflammation affecting multiple joints (usually five or more). This may be symmetrical or asymmetrical, and may have a particular pattern of joint involvement.
  • Patterns of Involvement

  • Symmetric polyarthritis: affects joints both sides in a symmetrical mannerRheumatoid arthritis, systemic lupus erythematosus
  • Asymmetric polyarthritis: patchy joint involvementAnkylosing spondylitis, psoriatic arthritis, reactive arthritis, grout, pseudogout, septic arthritis
  • Distal interphalangeal (DIP) involvementSuggests osteoarthritis
  • MCP and PIP involvement with DIP sparingClassically rheumatoid arthritis
  • Sacroiliac involvementSuggests spondyloarthropathy - ankylosing spondylitis or psoriatic arthritis
  • Hip & knee involvementSuggests osteoarthritis
  • Ankle involvementSuggests spondyloarthropathy - ankylosing spondylitis, psoriatic arthritis, reactive arthritis
  • Metatarsophalangeal involvementClassically gout (involvement of this joint with gout is called podagra)
  • Causes of Polyarthritis

  • Rheumatoid arthritis
  • Seronegative spondyloarthropathies - reactive arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease-related arthritis
  • Crystal arthropathies - gout, pseudogout
  • Osteoarthritis
  • Connective tissue disease - systemic lupus erythematosus, mixed connective tissue disease
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