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Whereas rheumatoid arthritis (RA) is the foremost common type of inflammatory arthritis, the diagnosis is not invariably easy to make. The reason is that there are more than one hundred completely different sorts of arthritis. Most of them involve inflammation. When a patient goes to a rheumatologist to induce a diagnosis, there is a method of elimination so as to arrive at the proper diagnosis. This method of elimination is named "differential diagnosis."
Differential diagnosis can be a troublesome enterprise as a result of thus many kinds of arthritis, notably inflammatory sorts of arthritis look alike. Typically it's useful to divide the differential diagnosis of rheumatoid arthritis into 2 groups. The primary cluster are the non-infectious diseases to think about and therefore the second cluster are the infection-related conditions.
In part 1 of this text, I discussed the non-infectious causes of arthritis that need to be considered when assessing a patient with attainable rheumatoid arthritis. In this article I will discuss those sorts of arthritis that are directly or indirectly thanks to infections.
Many infections will present with arthritis thanks to either direct inoculation of a joint (either from the surface or from a bloodstream infection) or due to autoimmune reactions. In several instances, infections lead to acute single joint arthritis; however, in some cases, chronic single or multiple joint arthritis can be present.
Missed infections will result in important complications; therefore, it is vital to own a high index of suspicion for infection in any patient presenting with acute or chronic arthritis.
Here are some examples:
Gonococcal arthritis is an infection because of the organism that causes gonorrhea (N. gonorrhea). It usually affects one joint (in 90% to ninety five% of cases). Symptoms embody:
o Joint pain that migrates (jumps around) for 1 to 4 days;
o Pain within the hands/wrists because of inflammation of tendons;
o Sometimes one joint will be inflamed;
o Fevers;
o Skin rash;
o Burning on urination;
o Lower abdominal pain.
The diagnosis of gonorrhea is made by taking the history and by culture or DNA polymerase chain reaction (PCR) analysis of areas of potential infection, as well as the throat, genitals, and anus. Since the organism that causes gonorrhea is tough to grow, it can often be missed on culture. Gonococcal arthritis can typically be distinguished from rheumatoid arthritis (RA) by clinical presentation, blood tests, and cultures.
Lyme disease may be a bacterial infection thanks to the spirochete Borrelia burgdorferi. It presents with a skin rash, swollen joints and flu-like symptoms, caused by the bite of an infected tick. Symptoms could include:
o A skin rash, typically resembling a bulls-eye; the rash could be more widespread, though;
o Fever;
o Headache;
o Muscle pain;
o Stiff neck;
o Numbness and tingling
o Bell's palsy
o Swelling of knees and different giant joints.
The diagnosis of Lyme disease is typically made by blood tests. Standardization of Lyme tests has improved greatly in the previous few years. If chronic single joint arthritis develops, joint fluid analysis or joint tissue biopsy could be necessary for diagnosis. Lyme arthritis can sometimes be distinguished from RA by clinical presentation and blood testing.
Acute rheumatic fever (ARF) is an inflammatory disease that may develop after an infection with Streptococcus, the bacteria that causes strep throat and scarlet fever. The disease will have an effect on the center, joints, skin, and brain. Symptoms include:
o Fever;
o Arthritis (mainly affecting the knees, elbows, ankles, and wrists);
o Skin rash and skin nodules;
o A peculiar movement disorder, known as Sydenham's chorea;
o Epistaxis (nosebleeds);
o Heart problems;
o Abdominal pain;
ARF is diagnosed by history, physical exam, and blood testing for antibodies against streptococcus. ARF and RA will have similar clinical options as well as arthritis and nodules. But, ARF will typically be distinguished from RA. For example, rash and migratory arthritis (arthritis that moves from joint to joint) are uncommon in RA. Blood tests are also useful for making the distinction.
Bacterial endocarditis (BE) happesn when bacteria from the skin, mouth or intestines enter the bloodstream and infect the guts valves and heart lining. Symptoms embody fever, chills, and alternative flu-like symptoms with unexplained weight loss and weakness. Diagnosis is made by blood cultures and ultrasound imaging of heart valves. Rheumatoid factor can be elevated in endocarditis, thus it is not helpful for distinguishing BE from RA.
Arthritis may be a symptom of the many viral illnesses. The length is typically short. Clinical features in adults embody:
Joint symptoms occur in up to sixty%. Joint pains are more common than true joint inflammation. The joint pains usually don't last long. They're symmetric, and affect tiny joints of the hands, wrists, knees, and ankle joints. Morning stiffness and swelling will be present. A rash could be gift
The foremost common cause of viral arthritis is most likely Parvovirus B19.
Diagnosis of viral arthritis is usually created by blood testing.
RF testing is not useful in distinguishing between hepatitis C infection and RA as a result of RF levels can be elevated in patients with hepatitis C. However, in these situations, testing for anti-cyclic citrullinated peptide (anti-CCP) will be helpful since these antibodies don't seem to be considerably elevated in hepatitis C infections.
