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inflammatory arthritis
Etiology:
- rheumatoid arthritis
- spondyloarthritis
- systemic lupus erythematosus
- infectious arthritis
- crystalline arthritis
Clinical manifestations:
- morning stiffness > 60 minutes
- fever, fatigue, malaise
- erythema, warmth, soft tissue swelling, joint effusions
- reduced range of motion
Laboratory:
- C-reactive protein in serum elevated
- erythrocyte sedimentation rate elevated
- complete blood count may show anemia of chronic inflammation
- synovial fluid analysis:
- WBC count > 2000 x10E9/uL
- neutrophil predominant with acute inflammation
- monocyte predominant with chronic inflammation
- troponin I in serum predicts excess cardiovascular mortality [1]
Differential diagnosis:
- non-inflammatory arthritis
- morning stiffness < 30 minutes
- fever, fatigue, malaise generally absent
- minimal or no erythema, warmth, no soft tissue swelling
- joint effusions & reduced range of motion may occur with osteoarthritis
- synovial fluid analysis:
- WBC count < 2000 x10E9/uL (predominantly monocytes)
- C-reactive protein in serum & erythrocyte sedimentation rate normal or minimally elevated [2]
- acute monoarthritis on a background of well-controlled inflammatory arthritis suggests infectious arthritis
General
arthritis
inflammation
References
- Walsh N.
Troponin Predicts Mortality in Inflammatory Arthritis.
High levels associated with all-cause and cardiovascular death.
MedPage Today. May 01, 2018
https://www.medpagetoday.com/meetingcoverage/bsr/72632
- Skeoch S, et al
The association of high sensitivity troponin levels with
subsequent cardiovascular mortality in an inflammatory
arthritis cohort: Results from the Norfolk arthritis register.
British Society for Rheumatology (BSR) 2018; Abstract O10.
- Medical Knowledge Self Assessment Program (MKSAP) 19
American College of Physicians, Philadelphia 2022