ACUTE MONOARTHRITISBERGER’S B’S

• BUGS

• BLOOD

• BIREFRIGENCE

CALCIUM PYROPHOSPHATE (cppd)

• Acute pseudogout

• Female predominant

• Knees/Shoulders/Wrists/MCP’s

• High fever and sed rate possible

• Can coexist in same joint with true infectious etiology: Unlike gout

CALCIUM HYDROXYAPATITE

• “Milwaukee Shoulder”

• Shoulders/knees/hips

• Hemarthrosis associated

• Rotator cuff destruction

• Fever and high sed rate less common than in CPPD

Musculoskeletal Presentations of Infectious Diseases

• Known systemic infectious diseases with musculoskeletal presentations

• Probable infectious agent causing systemic rheumatic disease

Post Streptococcal Arthritis(Rheumatic Fever)

• Shoulder “periarthritis” (80% in Persellin series in 1970’s)

• Classical migratory large joint synovitis rare

• Nodules/Carditis/Athetosis rare

• E nodosum more common than E marginatum

Gonorrhea

• Monoarticular/Pauciarticular synovitis: Large joint predominance

• Recovery of organism from joint 10% or less. Smears negative

• When recovered from joint, Rx the same as Staph septic joint: Recurrent aspirations

KAWASAKI DISEASE

• Fever lasting at least 5 days

• Bilateral conjunctivitis

• Oral mucous membrane changes

• Peripheral extremity changes

• Polymorphus rash

• Cervical lymphadenopathy

• Lab markers of inflammation

KAWASAKI DISEASE

• Inflammatory Arthritis: 15-25 %

• Diarrhea/Abd pain: 50%

• Cough: 35 %

• CORONARY ARTERITIS WITH ANEURYSMS: ? 100% ACUTELY

• IVIG AND ASA!!!

Parvovirus: B19

• Rheumatoid Arthritis look alike: Symmetrical Polyarthritis involving hands/wrists/knees/feet

• + RF and ANA 20-30%

• + cryoglobulins

• 6 month course

• Steroids occasionally required

HEPATITIS B• Symmetrical polyarthritis:small

joints

• Sometimes Urticarial rash

• Prodrome to jaundice

• Low serum complements

• Sometimes with glomerulonephritis

RUBELLA

• Large joint oligoarthropathy almost always involving knees

• Can last months

• Chronic RA look alike described after initial infection

• Can occur after immunizations

LYME DISEASE

• True arthritis tertiary manifestation– Arthralgia common in secondary stage

• Pauciarticular large joint arthopathy

• Thought intially to be JRA– One mother and local PTA + YALE

REACTIVE ARTHRITIS SYNDROME

• 90% with preceding chlamydial infection vs. bowel pathogen– Also described after Chlamydia

Pneumonia and Mycoplasma Pneumonia

• Chlamydial antigen demonstrated in synovium in involved joints– ?? Controls

– ?? Immunological mechanism

LOFGRENS SYNDROME

• Acute Histoplasmosis/Sarcoidosis

• Fever

• Erythema Nodosum

• Ankle Periarthritis

• Hilar Adenopathy

• Occasional uveitis/parotitis

• Usually resolves without sequelae

GIANT CELL ARTERITIS

• Temporal /Takayasu’s arteritis– Old Scandinavian women vs. young

Japanese/Israeli/Mexican women

– Carotid vs. aortic arch circulation

• Systemic symptoms: FUO presentation

• Symmetrical polyarthritis: 10%

• Sed rates!!!!!!!!

• Parvovirus anectdotes: Mayo data

BEHCET’S SYNDROME

• Painful oral and genital ulcers

• Uveitis: Anterior and posterior

• “Pathergic” skin rash

• Aseptic meningitis

• Hypercoaguability

• Pulmonary arterial aneurysms

• TNF excess: Therapeutic options

Relapsing Polychondritis

• True cause of ER Dx of costochondritis

• Chondritis/scleritis/vasculitis

• Fever and arthritis

• Palpable purpura

• Subglottic stenosis

• Tracheal collapse

• Rx with steroids and immunosuppresion