Diagnostic Approach in Patients With Arthritis PDF
Diagnostic Approach in Patients With Arthritis PDF
Diagnostic Approach in Patients With Arthritis PDF
Basic Principle in Arthri(s
Review of Organs System
Manifestation Disease
Acute monoarthri(s,
undergo an urgent
arthrocentesis to
examine the synovial fluid,
For analysis, culture, gram
stain and search crystal
Radiologic : can be
misleading, erosion, fracture,
degenera(v
Acute oligoarthri(s
Acute Oligoarthri(s
Infeksi Disseminated gonococcal infec5on a
Nongonococcal sep5c arthri5s
Bacterial endocardi5s b
Viral c
Post infeksi Reac(ve arthri(s b
Rheuma(c fever (poststreptococcal
arthri(s)
Spondyloarthropathy Reac(ve arthri(s b
Ankylosing spondyli(s b
Psoria(c arthri(s b
Inflammatory bowel disease b
Gout dan pseudogout
Systemic autoimmune disease rheumatoid arthri(s, systemic lupus
erythematosus,adult-onset S(ll disease,
relapsing polychondri(s,
Asymmetric, Inflammatory
Oligoarthri(s
Acute oligoarthri(s
• Urinalysis
• Haematology - FBC, ESR, clobng Radiology :
• Biochemistry - LFTs, urate, CRP
• Immunology Can be mis leading
• Microbiology Degenera(v joint
– blood/urine/stool/urethral/ erosion
sputum cultures
– Serology
• Synovial fluid
§ volume/viscosity/cellularity
§ polarised light microscopy
(crystals)
§ gram stain/culture
Acute Polyarthri(s
Acute Polyarthri(s
Common
Acute viral infec5ons
Early disseminated Lyme disease
Rheumatoid arthri5s
Systemic lupus erythematosus
Uncommon or rare
Paraneoplas5c polyarthri5s
RemiSng seronega5ve symmetric polyarthri5s with piSng edema
Acute sarcoidosis, usually with erythema nodosum and hilar
adenopathy
Adult-onset S5ll disease
Secondary syphilis
Systemic autoimmune diseases and vasculi5des
Whipple disease
Viral Arthri(des - Parvovirus
Acute Polyarthri(s - Psoria(c
Acute Polyarthri(s
Screening tests for acute polyarthritis
• Blood cultures
• Antistreptolysin O titer
• Parvovirus B-19 immunoglobulin G and
immunoglobulin M levels
• ANA test,HIV test, a rubella titer, anti CCP,
and ANCA
• Radiologic : cannot helpfull
Differen(al Diagnosis of
Chronic Inflammatory Monoarthri(s
Infection Sarcoidosis
Nongonococcal septic arthritis
Gonococcal Uncommon or rare
Mycobacterial FMF
Fungal Amyloidosis
Viral Pigmented villonodular synovitis
Crystal-induced arthritis
Gout Non-inflammatory
Pseudogut
Osteoarthritis
Monoarticular presentation of oligoarthritis Internal derangements (eg,torn,meniscus)
or polyarthritis Chondromalacia patella
Osteonecrosis
Spondyloarthropathies Neıropathic (charcot) arthropathy
Rheumatoid arthritis
Lupus and other systemic autoimmune
diseases.
Chronic monoarthri(s
• LABORATORY EVALUATION
• A cri(cal step is to determine whether the monoarthri(s is
inflammatory, preferably by analyzing synovial fluid.
• Synovial fluid should be sent for culture (bacterial,
mycobacterial, and fungal), WBC count, and gram stain and
examined for crystals by polarized light microscopy.
• Culture synovial and biopsy
• Radiology/imaging, very useful
CHRONIC OLIGOARTHRITIS
Common inflammatory causes Common non-inflammatory causes
Spondyloartropa5es Osteoarthri5s
Reac5ve arthri5s Uncommon-rare non inflammatory
Ankylosing spondyli5s Hypotyroidism
Psoria5c arthri5s amyloidosis
Inflammatory bowel disease
Uncommon-rare inflammatory arthri5s
Subacute bacterial endocardi5s
Sarcoidosis
Behçet disease
Celiac disease
Arthri5s of axial skeleton
Features of Spondyloarthropathies (1)
Paraneoplastic polyarthritis
Remitting seronegative symmetric
polyarthritis with pitting edema (RS3PE)
Adult onset still disease
CLINICAL PRESENTATION
• Pattern of joints affected with psoriatic arthritis is different than those with rheumatoid
arthritis.