TOC  | D-Dx     Joint Swelling Differential - Outlines in Clinical Medicine on Physicians' Online 2001

A. Hypersensitivity
Erythema multiforme ("Target Lesion")
Drugs: TMP/SMX (Bactrim®), Ampicillin
Bacterial Infection: Streptococcus
Viral: Herpes, Cocksackie, Adenovirus, Hepatitis B (PAN), Hepatitis C (cryoglobulinemia)
Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis (TEN)

B. Trauma Direct Bleeding Diathesis

C. Infection Bacteria: gonococcus, streptococcus, chlamydia
    Virus Spirochete: especially Lyme Disease, Rickettsia, Mycoplasma

D. Neoplastic Bone Cartilage Leukemia

E. Collagen-Vascular Disease
Rheumatoid Arthritis, Juvenile Rheumatoid Arthritis, Systemic Lupus Erythematosus, Mixed Connective Tissue Disease, Henoch-Schšnlein Purpura, Kawasaki Disease, Periarteritis (HUS/TTP), Reiter's Syndrome

F. Metabolic:  Gout: tophus formation, asymmetrical Pseudogout (CPPD), Hemochromatosis

G. Hematologic: Leukemia, Hemophilia ,von Willebrand's Disease

H. Associated Disease Inflammatory Bowel Disease, Psoriasis, Lyme (associated) Arthritis Diarrhea associated

I. Polyarthritis

  1. Fever >40°C : Still's Disease ,Bacterial Arthritis ,Systemic Lupus (SLE)
  2. Fever prior to arthritis:  Viral arthritis, Lyme Disease, Reiter's Disease, Post-Gastrointestinal Infection, Still's Disease, Endocarditis
  3. Migratory:  Gonococcemia, Meningococcemia, Viral Arthritis, SLE, Acute Leukemia, Rheumatic Fever, Whipple's Disease
  4. Large Effusion:  TB Arthritis Endocarditis IBD Associated Temporal Arteritis Lyme Disease
  5. Rheumatoid Factor Positive:  Rheumatoid Arthritis Viral Arthritis Endocarditis TB SLE Sarcoidosis Other CVD
  6. Morning Stiffness:  RA Polymyalgia Rheumatica Still's Disease
  7. Symmetric:  Small Joint Effusions Rheumatoid Arthritis, SLE, Viral Arthritis
  8. Leukocytosis:  Bacterial Arthritis / Endocarditis, Still's Disease, Systemic Vasculitis, Acute Leukemia
  9. Leukopenia:  SLE, Viral Arthritis
  10. Episodic: Lyme Disease, Crystal Disease, IBD, Whipple's Disease, Mediterranean Fever, Still's Disease, SLE

J. STAR Complex  (STAR = Sore Throat / Temperature / Arthritis / Rash)

  1. Acute <3 weeks: Rubella, Parvovirus, Hepatitis B Virus, Adenovirus, Echovirus, Coxsackie-virus, Epstein-Barr Virus, Lyme Disease - Borellia burgdorferei,  Serum Sickness
  2. Chronic >3-6 weeks: Acute Rheumatic Fever, Juvenile Rheumatoid Arthritis, Still's Disease

        

04182001