2. ACUTE MONOARTHRITIS BERGER’S B’S
BUGS
BLOOD
BIREFRIGENCE

7. 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

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

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

12. 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

14. 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

17. 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

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

21. 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

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

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

27. 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

32. 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

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

36. 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

38. 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

41. 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