What Is Polyarthritis?

Polyarthritis Is Associated With Acute and Chronic Conditions

Arthritic hand indicative of polyarthritis
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Polyarthritis is defined as pain, with or without inflammation, that affects more than four joints. With polyarthritis, over time, there is a risk of even more joint involvement. Polyarthritis is also sometimes referred to as polyarthralgia. Arthralgia means painful joints. Arthritis means inflamed joints. Monoarthritis affects one joint. Oligoarthritis typically means that two to four joints are affected.

Evaluating Symptoms

A doctor who is consulted by someone with more than 4 affected joints must diagnose the condition so that appropriate treatment can begin. There are several conditions that may be associated with polyarthritis. A patient's medical history and physical examination will likely provide the most important clues to help formulate the diagnosis. The doctor should initially look for signs of trauma, osteoarthritis, or fibromyalgia. Osteoarthritis and fibromyalgia are the two most common causes of polyarthralgia and widespread musculoskeletal pain.

The disease course should be evaluated to distinguish between acute or chronic polyarthritis. The distinction should also be made between articular (i.e., involving the joints) or periarticular conditions (i.e., involving tendons, ligaments, bursae, or muscles—the supporting structures around the joints). A determination must also be made about the presence of inflammation, or lack of.

Pain during rest and morning stiffness that improves with activity are suggestive of joint inflammation. Pain that worsens with activity but is relieved with rest is typically non-inflammatory.

Warmth and redness point towards an inflammatory condition. Prolonged morning stiffness, stiffness after prolonged inactivity, non-traumatic joint swelling, fever, and unintentional weight loss are characteristic of a systemic inflammatory disease that involves the joints.

The pattern of joint involvement can provide important diagnostic clues as well. Typically, involvement of the distal interphalangeal joints (DIP joints) of the hand points to osteoarthritis or psoriatic arthritis. Involvement of the proximal interphalangel joints (PIP joints) or the metacarpophalangeal joints (MCP joints) is usually associated with rheumatoid arthritis. When large joints are involved, such as the hips or shoulders, polymyalgia rheumatica or one of the spondyloarthropathies are the chief suspects. Symmetric joint involvement (i.e., same joint affected on both sides of the body) is a sign typically associated with rheumatoid arthritis. Asymmetric joint involvement is more likely to be psoriatic arthritis, gout, reactive arthritis, or enteropathic arthritis. If joint effusion is present, an arthrocentesis can be performed to rule out infection, to diagnose crystal-induced arthropathy, and to distinguish between an inflammatory and non-inflammatory disease process.

Conditions Associated With Polyarthritis

Acute non-inflammatory polyarthritis includes:

Chronic non-inflammatory polyarthritis includes:

  • Osteoarthritis

Acute inflammatory polyarthritis includes:

  • Viral arthritis
  • Serum sickness
  • Drug-induced arthritis
  • Connective tissue disease
  • Rheumatic fever
  • Palindromic rheumatism
  • RS3PE (remitting seronegative symmetric synovitis with pitting edema)

Chronic inflammatory polyarthritis includes:

The Bottom Line

The differential diagnosis of polyarticular joint pain largely depends on the number and type of joints affected, whether inflammation is present, whether joint involvement is symmetric or asymmetric, and if there are any extra-articular symptoms (i.e., other than joints). Early diagnosis is important so that treatment may be initiated.

Sources:

Kelley's Textbok of Rheumatology. Ninth Edition. John J. Cush and Kathryn H. Dao. Chapter 42. Polyarthritis.

Klinkhoff, Alice. CMAJ (Canadian Medical Association Journal). Rheumatology: 5. Diagnosis and management of inflammatory polyarthritis. June 27, 2000.

Villa-Forte, Alexandra MD, MPH. Pain in Multiple Joints. Merck Manual Profesional Version. Last revision December 2013.

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