ACUTE MONOARTHRITIS BERGER’S B’S BUGS BLOOD BIREFRIGENCE

CALCIUM PYROPHOSPHATE (cppd) Acute pseudogout Female predominant Knees/Shoulders/Wrists/MCP’s High fever and sed rate possible Can coexist in same joint with true infectious etiology: Unlike gout

CALCIUM HYDROXYAPATITE “Milwaukee Shoulder” Shoulders/knees/hips Hemarthrosis associated Rotator cuff destruction Fever and high sed rate less common than in CPPD

Musculoskeletal Presentations of Infectious Diseases Known systemic infectious diseases with musculoskeletal presentations Probable infectious agent causing systemic rheumatic disease

Post Streptococcal Arthritis (Rheumatic Fever) Shoulder “periarthritis” (80% in Persellin series in 1970’s) Classical migratory large joint synovitis rare Nodules/Carditis/Athetosis rare E nodosum more common than E marginatum

Gonorrhea Monoarticular/Pauciarticular synovitis: Large joint predominance Recovery of organism from joint 10% or less. Smears negative When recovered from joint, Rx the same as Staph septic joint: Recurrent aspirations

KAWASAKI DISEASE Fever lasting at least 5 days Bilateral conjunctivitis Oral mucous membrane changes Peripheral extremity changes Polymorphus rash Cervical lymphadenopathy Lab markers of inflammation

KAWASAKI DISEASE Inflammatory Arthritis: 15-25 % Diarrhea/Abd pain: 50% Cough: 35 % CORONARY ARTERITIS WITH ANEURYSMS: ? 100% ACUTELY IVIG AND ASA!!!

Parvovirus: B19 Rheumatoid Arthritis look alike: Symmetrical Polyarthritis involving hands/wrists/knees/feet + RF and ANA 20-30% + cryoglobulins 6 month course Steroids occasionally required

HEPATITIS B Symmetrical polyarthritis:small joints Sometimes Urticarial rash Prodrome to jaundice Low serum complements Sometimes with glomerulonephritis

RUBELLA Large joint oligoarthropathy almost always involving knees Can last months Chronic RA look alike described after initial infection Can occur after immunizations

LYME DISEASE True arthritis tertiary manifestation Arthralgia common in secondary stage Pauciarticular large joint arthopathy Thought intially to be JRA One mother and local PTA + YALE

REACTIVE ARTHRITIS SYNDROME 90% with preceding chlamydial infection vs. bowel pathogen Also described after Chlamydia Pneumonia and Mycoplasma Pneumonia Chlamydial antigen demonstrated in synovium in involved joints ?? Controls ?? Immunological mechanism

LOFGRENS SYNDROME Acute Histoplasmosis/Sarcoidosis Fever Erythema Nodosum Ankle Periarthritis Hilar Adenopathy Occasional uveitis/parotitis Usually resolves without sequelae

GIANT CELL ARTERITIS Temporal /Takayasu’s arteritis Old Scandinavian women vs. young Japanese/Israeli/Mexican women Carotid vs. aortic arch circulation Systemic symptoms: FUO presentation Symmetrical polyarthritis: 10% Sed rates!!!!!!!! Parvovirus anectdotes: Mayo data

BEHCET’S SYNDROME Painful oral and genital ulcers Uveitis: Anterior and posterior “Pathergic” skin rash Aseptic meningitis Hypercoaguability Pulmonary arterial aneurysms TNF excess: Therapeutic options

Relapsing Polychondritis True cause of ER Dx of costochondritis Chondritis/scleritis/vasculitis Fever and arthritis Palpable purpura Subglottic stenosis Tracheal collapse Rx with steroids and immunosuppresion