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Hand & Wrist Exam

Patterns of Arthropathy

October 12th, 2020


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 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 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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