What are the common causes of polyarthritis (5 or more joints involved)?

Causes of polyarthritis (5 or more joints involved)

  • Rheumatoid arthritis: Symmetrically involve both small and large joints of all 4 limbs. 
  • Viral arthritis: Symmetrically involve small joints and usually self-limiting. Prodromal illness and few rashes may be present 
  • Osteoarthritis: It affects bilaterally and in a symmetrical fashion. Mainly affected joints are hands joints (proximal interphalangeal, distal interphalangeal and first carpometacarpal), knees, hips, lumbar and cervical spines). May be associated with Heberden's and Bouchard's nodes 
  • Psoriatic arthritis: Asymmetrical. It may affect all joints and entheses; associated with nail pitting/ onycholysis, dactylitis 
  • Axial spondyloarthritis and enteropathic arthritis: involve medium and large joints and entheses. Affect lower limb joints more, than upper limbs. 
  • SLE: Symmetrically affect small joints. 
  • Juvenile idiopathic arthritis: Enthesitis is predominant. Some systemic features may be present 
  • Chronic gout: Affects distal more than proximal joints. There will be a history of acute attacks 
  • Chronic sarcoidosis: Involve small and large joints, often involves ankles 
  • Calcium pyrophosphate arthritis: Chronic polyarthritis with the involvement of wrists, ankles, knees and oligoarticular small hand joints. 
[Source: Davidson's principles and practice of medicine 23rd Edition; page 993]

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