0071643192.pdf

ORTHOPEDICS

■ Fever, most commonly with septic arthritis

■ Characterized by number of joints (mono, poly, oligo), symmetry, migratory

DIFFERENTIAL

■ Bursitis

■ Tendonitis

■ Fracture

■ Cellulitis

TABLE 4.6. Causes of Symmetric Polyarthritis

CONDITION JOINTSINVOLVED UNIQUEFEATURES TREATMENT

Rheumatoid Hand (MCP and PIP Women in their 20s and 30s; associated NSAIDs, immunosuppressants,

joints), wrist with HLA-DR4 haplotype; early antimalarials, gold, methotrexate

morning stiffness; sparing of DIP joints;

multisystem involvement common

Systemic lupus All. Usually PIP and Women 15—40 years old; can be NSAIDs, immunosuppressants

MCP joints of the hand migratory; associated with rash:

malar, discoid, or photosensitivity

Rheumatic fever Large joints (knees, Migratory NSAIDs, immunosuppressants

ankles, elbows, wrists)

Viral All joints

TABLE 4.7. Causes of Asymmetrical Polyarthritis

CONDITION JOINTSINVOLVED UNIQUEFEATURES TREATMENT

Reiter syndrome Weight-bearing joints Males 15—30 years old; triad: conjunctivitis, NSAIDs; antibiotics not

(reactive arthritis) (sacroiliac, hip, knee) urethritis, arthritis;80—90% are HLA-B27 helpful

positive; often preceded 2—6 wks by viral

illness, diarrhea, or infection with Chlamydia

orUreaplasma

Gonococcal Wrist, hand, ankle Young sexually active adults; often associated Penicillin

with a vesiculopustular lesions on the fingers;

can be migratory; synovial fluid cultures

often negative

Henoch-Schönlein Ankle, knee Children 4—12 years old; triad: migratory NSAIDs

purpura arthritis, palpable purpuric rash on

lower extremities, abdominal pain

Lyme Knee Migratory; occurs monthsafter the initial Antibiotics (doxycycline,

infection amoxicillin, Penicillin G,

ceftriaxone)

Reiter syndrome: Can’t see

(conjunctivitis), can’t pee

(urethritis), can’t bend my

knee (arthritis)