MANUAL MINORS
Polyarthritis is defined as the simultaneous inflammation of five or more joints. This condition can be caused by a variety of diseases, including autoimmune disorders, infections, or metabolic conditions. Patients typically present with pain, swelling, and stiffness in multiple joints, affecting their mobility and quality of life.
Diagnosis
The diagnosis of polyarthritis begins with a detailed medical history and physical examination to identify the affected joints. It is essential to ask about recent infections, autoimmune diseases, or systemic symptoms.
Laboratory tests, such as a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibodies (ANA), and imaging studies like X-rays or ultrasounds are used to assess joint damage. In some cases, synovial fluid aspiration may be necessary for analysis.
Diferencial Diagnosis
Disease | Key Characteristics |
|---|---|
Rheumatoid arthritis | Primarily affects small joints, morning stiffness, positive ANA and RF. |
Systemic lupus erythematosus | Affects multiple organs, malar rash, positive ANA and anti-DNA antibodies. |
Psoriatic arthritis | Associated with psoriasis, asymmetrical involvement, distal joint involvement. |
Rheumatic fever | History of streptococcal infection, carditis, chorea, subcutaneous nodules. |
Gout | Acute pain attacks, urate crystals in synovial fluid. |
Infectious arthritis | Mono or polyarthritis with fever, purulent synovial fluid. |
Emergency Management
In the emergency department, initial management of polyarthritis focuses on relieving pain and inflammation while stabilising the patient as a diagnosis is made. Analgesics, such as NSAIDs (non-steroidal anti-inflammatory drugs), or systemic corticosteroids in severe cases, are administered.
If infectious arthritis is suspected, broad-spectrum antibiotics should be started empirically while awaiting synovial fluid analysis results. Joint aspiration is essential to rule out infection or crystals.
Definitive Treatment
The definitive treatment depends on the underlying cause of the polyarthritis. For autoimmune diseases such as rheumatoid arthritis or lupus, disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, leflunomide, or biologic agents, are used.
For infectious arthritis, treatment involves intravenous antibiotics, while in cases of crystal-induced arthritis, such as gout, medications to lower uric acid levels (allopurinol or febuxostat) are employed.
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