Sufferers with inflammatory polyarthritis (i.e., irritation in more than four joints) are a diagnostic and management challenge. When signs are of recent onset, the range of possible diagnoses is great. Certain viruses together with those that cause rubella, and mumps, human parvovirus B19 and some enteroviruses may cause acute polyarthritis; nonetheless, these viral arthritides usually subside within 6 weeks without sequelae. The prodrome of acute hepatitis B an infection and infection with the Lyme disease agent, Borrelia burgdorferi, might embrace polyarthritis. The former is acknowledged by the following hepatitis, whereas the latter requires an excessive index of suspicion (i.e., a historical past of tick chunk or a typical rash on an affected person from an endemic area) and infrequently entails only 1 or 2 massive joints.

In sufferers who’re beneath 50 years of age with joint ache and swelling lasting longer than 6 weeks the diagnoses to be thought-about embrace rheumatoid arthritis, psoriatic arthritis, other seronegative spondyloarthropathies and SLE. In sufferers over 50 years of age, crystal-induced synovitis should also be considered. Osteoarthritis may also trigger considerable inflammation within the affected joints. For many of those situations specific therapies aimed toward controlling irritation, preserving range of movement in the joint and stopping joint harm are successful in lowering morbidity and bettering high quality of life.

The patient with symptoms in lots of joints requires a detailed history and bodily examination. If there’s morning stiffness lasting greater than 30 minutes or stiffness after sitting, the joint complaints are likely to be brought on by irritation; a convincing historical past of joint swelling confirms the presence of inflammation. The physician ought to document the onset and development of symptoms and the distribution of joints affected. A history of psoriasis within the affected person or a member of the family is an important clue to the possibility of psoriatic arthritis.

The physician should also inquire about a history of iritis or inflammatory bowel illness, both of that are associated with seronegative spondyloarthropathies. A latest episode of infectious diarrhea or genitourinary infection are clues to possible Reiter’s syndrome. Does the patient have symptoms suggestive of SLE (e.g., photosensitive or malar rash, alopecia or pleurisy)? Is there a previous history of acute episodes of arthritis or gout? Are the joints tender or swollen? Is motion limited? The choice of laboratory tests which will help depend on the differential diagnosis.

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