What is Polyarticular Arthritis?
Doctors often see patients who complain of pain in all their joints. While it might be tempting to diagnose a rare or unusual disease, most of the time these patients have issues that are temporary or insignificant. To identify the root cause of the problem, doctors carefully listen to the patient’s health history and carry out a physical examination. This could help cut down a long list of potential causes to a few possibilities, which can then be confirmed or ruled out through medical tests. These might include blood tests, scans, body tissue samples or other advanced checks.
Although such tests are available, the most helpful actions towards diagnosing the problem are asking specific, detailed questions and conducting a physical examination. These steps also help in saving healthcare resources by avoiding expensive checks that might not be necessary.
To find out what’s causing the inflammation, the doctor first determines if it’s coming from the joint or a nearby area. It’s common for non-joint and near-joint areas to be painful and confusing, with the pain often spreading to the joint. If the inflammation and pain are indeed arising from the joint, it could be either due to an inflammatory issue or a non-inflammatory one.
Non-inflammatory causes, such as osteoarthritis (a common, long-lasting joint disease), usually create chronic, mild pain without major signs of inflammation such as redness, warmth, swelling, and overall body disturbances. If the issue appears to be inflammatory, the doctor will confirm this through tests and seek to identify the problem based on factors like the number, pattern, duration, and symmetry of the affected joints.
What Causes Polyarticular Arthritis?
Pain in your joints can be caused by a variety of factors that aren’t related to the joint itself. This can include an underactive thyroid, or hypothyroidism, depression, and conditions that cause your body to feel more pain than normal.
There are also conditions that may lead to joint pain caused by the area surrounding the joint, like inflammation of the bursa (bursitis), inflammation of the tendon (tendinitis), nerve pain (neuropathic pain), disorders that change the structure and strength of the bones (metabolic bone diseases), injuries to the soft tissue around the joints, and fibromyalgia, a condition that causes widespread pain throughout your body.
Non-inflammatory joint conditions, like osteoarthritis or degenerative arthritis, can also cause joint pain. This condition often occurs with age or wear and tear of the joints.
Joint pains can also arise from inflammatory arthritis, or inflammation of the joints. This can be caused by:
1) Bacteria: Lyme disease, endocarditis, septic arthritis.
2) Viruses: hepatitis B and C, Epstein Barr virus, parvovirus, dengue, alphaviruses, rubella, human immunodeficiency virus, mumps, coxsackievirus.
3) Diseases that impact connective tissue: rheumatoid arthritis, palindromic rheumatism, rheumatic fever, lupus, vasculitis, systemic sclerosis, myositis, ankylosing spondylitis, psoriatic arthritis, Behcet syndrome, and relapsing polychondritis.
4) Crystal-induced arthritis, which happens when there is a build-up of uric acid which causes gout, or calcium pyrophosphate which causes pseudogout.
5) Post-infectious or reactive arthritis, which happens as a reaction to an infection in the gut or from a disseminated gonococcal infection.
6) Familial Mediterranean fever, a genetic disorder that usually reveals itself through painful episodes of fever and inflammation.
It’s important to identify the underlying cause of the joint pain, as the treatments can vary dramatically. It’s critical to consult with a medical practitioner for evaluation and to find the right treatment.
Risk Factors and Frequency for Polyarticular Arthritis
According to the Arthritis Foundation, over 100 different types of arthritis exist. In 2015, they estimated that nearly 1 in 3 individuals aged between 18 to 64, equivalent to about 91.2 million adults, either had arthritis diagnosed by a physician or showed symptoms that are common for an arthritis diagnosis. This number increases with age, with half of all men and two thirds of women aged 65 and above having arthritis. Researchers predict that by 2040, almost half the population will have arthritis confirmed by a doctor.
Particularly common forms of arthritis, such as polyarticular arthritis, are more likely to occur in females and individuals who are overweight. The chance of developing arthritis also increases with age. The total financial impact of arthritis—including medical costs, lost earnings and time—equated to 1% of the US’s total economy, or $304 billion, in 2013.
Also, among individuals with arthritis, a significant percentage have other health conditions. These coexisting conditions can often be attributed to the physical inactivity that arthritis can cause.
- There are over 100 types of arthritis.
- About 91.2 million adults either have a diagnosis of arthritis or show symptoms of the disease. This represents nearly 1 in 3 individuals between the ages of 18 and 64.
- After the age of 65, half of men and two-thirds of women have arthritis.
- Arthritis, especially polyarticular arthritis, is more common in females and those who are overweight.
- The total cost of arthritis in 2013 was 1% of the US’s total economy ($304 billion).
- Among those with arthritis, 33% have depression or anxiety, 25% have heart problems, 20% have respiratory issues, and 16% have Diabetes.
Signs and Symptoms of Polyarticular Arthritis
Acute arthritis typically lasts a few hours to two weeks, while chronic arthritis is an inflammation that lasts over two weeks. Chronic symptoms can come and go or stay constant. The symmetry (whether it impacts both sides of the body) and the number of affected joints are important elements to consider. If only two to four joints are involved, it’s called “pauciarticular”, whereas “polyarticular” involves five or more joints. The size and type of joints, as well as whether it’s an inflammatory or non-inflammatory pattern, all play a crucial role in understanding arthritis.
Rheumatoid arthritis usually affects many joints, especially in hands and wrists, and affects both sides of the body. Symptoms tend to start slow and can last for weeks to months before a diagnosis is made. Seronegative spondyloarthropathies (a kind of arthritis that is not detected by certain tests) usually affects only a few joints with involvement of the spine and inflammation in larger joints. Osteoarthritis usually occurs in joints that carry more weight, is often not symmetrical, and tends to worsen with movement and improve with rest. Inflammatory arthritis is usually symmetrical, involves severe inflammatory patterns and affects joints that do not carry much weight. Experiencing morning stiffness for over an hour is commonly seen in inflammatory arthritis such as seronegative spondyloarthropathies.
With an acute onset and migratory pattern, it could be viral arthritis, rheumatic fever or disseminated gonococcal infection; though viral arthritis is much more common. However, viral arthritis is often resolved before a diagnosis can be confirmed. Septic joints, which are usually hot, swollen, red, and painful, are usually easy to diagnose. They are often an arthritis affecting just one large joint and come with general body symptoms. However, they rarely appear in a form affecting several joints. An acute infection of a preexisting arthritic joint can often complicate diagnosis.
- Worsening pain with movement and improvement with rest is characteristic of osteoarthritis, whereas rheumatoid arthritis worsens with inactivity and improves with movement.
- Short periods of synovitis (4-6 weeks) are usually due to viral infections, whereas longer periods suggest a persistent issue.
- Sensory issues like numbness, hypersensitivity, or loss of sensation could indicate nerve problems.
- Additional symptoms, like rashes, oral and genital lesions, heart murmurs, and dry eyes and mouth, can provide crucial information for diagnosis.
Physical examination can help confirm or rule out synovitis (inflammation of the lining of the joints) and may reveal chronic changes associated with long-standing arthritis. The clinician should examine muscles, joints, tendons, bursas (small fluid-filled sacs), and soft tissue. Both passive and active range of motion should be tested. Non-joint diseases often show normal passive range of motion but reduced active range of motion. Tendinitis or bursitis are good examples of this. Palpation (touching with fingers or hands) can help differentiate between these conditions. Joint diseases usually result in reduced active and passive range of motion.
Warmth, redness, swelling, and tenderness are the primary signs of inflammation and can make diagnosing inflammatory arthritis fairly simple. Septic arthritis presents these signs in a more pronounced form. A grinding sensation in the joint may suggest osteoarthritis, and joint laxity can indicate a damaged and unstable joint. Sometimes, findings outside the joints from the physical exam can be even more crucial for diagnosis.
Testing for Polyarticular Arthritis
If you’re experiencing pain in several joints, your doctor might need to conduct a range of tests to figure out why. These usually include looking for “markers” in your blood, like Rheumatic factor (RF) for rheumatoid arthritis, where your immune system mistakenly attacks your own body’s tissues, or anti-citrullinated peptide antibodies (CCP) relating to rheumatoid arthritis. Other tests check for markers linked to lupus, a disease causing inflammation to skin, joints and organs, systemic sclerosis, a disease causing skin tightening, Sjogren syndrome, affecting moisture-producing glands, mixed connective tissue disease, causing inflammation and damage to the body, granulomatosis with polyangiitis, causing inflammation of blood vessels, and Hepatitis C, a liver disease.
Looking at the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in your blood can also help; these are signs that your body is fighting an infection or another disease that’s causing inflammation. Further, examining the fluid in your joints can help diagnose things like gout, where uric acid crystallises in your joints causing inflammation, or arthritis. Normal levels are less than 200 cells/mm, but higher counts could indicate arthritis. Counts over 50,000 cells/mm could indicate an infection.
Finding markers for infectious diseases like Hepatitis, Lyme disease, a tick-borne illness, or parvovirus, a common virus that can cause joint inflammation, will also help diagnose why you might be experiencing joint pain.
Imaging, whilst it can be expensive and sometimes unhelpful in diagnosing the cause of joint pain, is also an option. While it’s not usually necessary to image every painful joint, some can provide useful information for diagnosing and treating your condition.
X-rays can be helpful in showing fractures, dislocations, advanced osteoarthritis, or abnormalities in bone structure that all can cause joint pain. However, they can also show arthritis signs without associated symptoms, which can be confusing. For rheumatoid arthritis specifically, x-rays can help monitor response to treatment and progression of the disease. X-rays can also detect damages early in seronegative spondyloarthropathies including ankylosing spondylitis and psoriatic arthritis. MRI might be better for detecting early inflammation or infection.
Ultrasound, while not commonly used in diagnosing joint pain of multiple joints, can be helpful for administering injections. Computed tomography (CT scans) and MRI scans can be used to rule out other conditions, and in certain cases, radionuclide scans might be used to detect other bone diseases.
Lastly, while not commonly needed for diagnosing joint pain, a biopsy can sometimes be the final step in confirming a diagnosis, particularly in cases of different blood vessel diseases, infections, or granulomatous diseases.
Treatment Options for Polyarticular Arthritis
In medical terms, the treatment of a disease is often determined by its diagnosis or identification. Here are some examples:
For a condition called osteoarthritis, several steps are taken. First, any irregularities in the physics of your body are corrected. You may need to lose weight and reduce stress on the joints affected. Keeping the areas warm and doing strengthening exercises can help improve your condition. The doctor might also recommend non-steroidal anti-inflammatory medications (NSAIDS) or use corticosteroid injections to manage your pain or swelling. Sometimes, if other treatments do not work, the joint may need to be replaced with an artificial one.
For collagen vascular diseases, which are diseases that affect your connective tissue, today’s treatments are very different from those of the past. Fifty years ago, doctors might have started you on NSAIDs, moved onto steroids, and then used a type of treatment that involved gold salts for severe cases. Today, they start treating aggressively with biological medications early on to prevent joint damage. NSAIDs are reserved for when the disease is advanced, and the damage is significant. The doctor might consider surgery if all else fails. There are now many types of biologic treatments available, which can be taken either orally or through injections.
If the source of arthritis is traced to an infection, antibiotics will be administered to treat the infection.
If you have what’s called crystal-induced arthritis, then you’ll likely be treated with chelating agents. These medications help to reduce the levels of the offending agent in the blood and prevent further damage to your joints.
What else can Polyarticular Arthritis be?
When diagnosing certain conditions, doctors have to consider a wide range of possible diseases. It’s important to make sure that the symptoms aren’t actually caused by any of the following common conditions:
- Psoriatic arthritis
- Tophaceous Gout
- Undifferentiated seronegative polyarthritis
- Erosive inflammatory arthritis
- Enteropathic arthritis
- SLE (Systemic lupus erythematosus)
- Scleroderma
- Polymyalgia rheumatica
What to expect with Polyarticular Arthritis
The outlook for each individual can be influenced by several factors including: how long the symptoms have lasted, the age when symptoms started, being male, being overweight, the number of joints affected, if the lower limbs are involved, the intensity of the inflammation, and high levels of the indicators of inflammation in lab test results.
Possible Complications When Diagnosed with Polyarticular Arthritis
Complications can vary greatly, as each disease brings about its own unique set of complications. These complications are typically dependent on factors such as how severe the disease is, where the inflammation is occurring, the individual’s health, and the treatments that are available.
Preventing Polyarticular Arthritis
Many resources are available for individuals with arthritis, which is a very common condition that has garnered much attention. Notable medical institutions such as the Arthritis Foundation, Mayo Clinic, and Johns Hopkins offer extensive resources that cover almost every aspect of this disease. These resources provide information about the nature of arthritis, advice for dealing with pain and disability, guidance on nutrition and rehabilitation practices, as well as the benefits of exercises and yoga. They also give an overview of different treatment options and their side effects. This wide range of information is designed to empower individuals with arthritis to understand their condition better and manage their symptoms effectively.
