1. Ilkin Bakirli Rheumatology 22.03.2019
How many Joints are affected in Polyarthritis and write diseases for which
Polyarthritis is typical
Polyarthritis is any type of arthritis that involves 4 or more joints simultaneously. It usually is
associated with an autoimmune condition and may be experienced at any age and is not gender
specific. In general, the joints become painful and inflamed. The condition is also known as
polyarticular arthritis.
Causes
Polyarthritis is most often caused by an auto-immune disorder such as rheumatoid arthritis,
amyloidosis, psoriatic arthritis scleroderma, juvenile idiopathic arthritis, sarcoidosis, Whipple
disease and lupus erythematosus but also with infections with alphaviruses such as chikungunya
virus and Ross River virus. Because autoimmune diseases tend to trigger an all-body response,
those involving the joints will usually not appear in isolation as they might with osteoarthritis.
Symptoms
Pain, stiffness, swelling or redness in the affected area, limited range of motion, rash, tiredness or
a lack of energy, warmth over the affected joint, lymphadenopathy, sweating, lack of apetite and
unexpected weight loss.
Diagnosis
1. History and physical examination: it is important to determine if the pain is symmetric or
asymmetric. Patients suffering from rheumatoid arthritis tend to experience symmetric
symptoms, while those with psoriatic arthritis often experience asymmetrical symptoms.
2. Laboratory: antibody testing can be done, specifically the rheumatoid factor (RF) test and
the anti- cyclic citrullinated peptide (anti-CCP) antibody test can help confirm diagnosis.
Other antibody tests and HLA phenotyping can be done to identify specific diseases.
3. Imaging- X-ray, Ultrasound, blood tests and arthrocentesis may be done to different
diseases to confirm the diagnosis.
Treatment
Treatments for polyarthritis are typically the same as for autoimmune diseases. They include:
1. Non-steroidal anti-inflammatory drugs (NSAIDs): Advil (ibuprofen), Aleve (naproxen),
and Voltaren (diclofenac) can help relieve pain and stiffness.
2. Disease-modifying anti-rheumatic drugs (DMARDs): These help slow the course of
autoimmune diseases. Methotrexate is frequently prescribed to reduce joint damage
caused by polyarthritis.
3. Biologics: These drugs, which include Remicade (infliximab) and Embrel (etanercept),
modify the immune system to reduce inflammation.
4. Corticosteroids: These help control inflammation and reduce pain. Steroids can be taken
orally or via injection. They should only be used in the short-term, as they can cause
serious side effects.
2. Ilkin Bakirli Rheumatology 22.03.2019
5. Warming therapies: Warm baths, warming mitts, and over-the-counter topical creams
such as Aspercreme can temporarily relieve symptoms.
6. Exercise: Low-impact exercises like swimming, yoga, and stretching, can help keep
joints healthy.
Some points about specific diseases causing polyarthritis
1. Polyarthritis in Rheumatoid arthritis: symmetrical polyarthritis, large and small joints
involved, firstly begins in the proximal interphalangeal joints and metacarpophalangeal
joints, later also affects the joints of the foot and other large joints, hand deformities such
as the boutenniere deformity or swan neck deformity.
2. Juvenile idiopathic polyarthritis: occurs in small and large joints from ankles, wrists and
hands to hips and knees.
3. Systemic lupus erythematosus: other than affecting joints, it also impacts kidneys, skin
and the central nervous system.
4. Psoriatic arthritis: it is associated with psoriasis (an autoimmune skin disease). Symptoms
include scaly, red rash and unilateral swelling of the fingers and toes.
