Oligoarticular Disease Research Articles

Tuberculous Polyarthritis

A 33-year-old man from Pakistan presented in London with a severely destructive polyarthritis 24 years after onset. Synovial biopsy and culture revealed evidence of tuberculous infection. It is probable that the polyarticular nature of his disease misled clinicians because the concept of tuberculous arthritis perpetuated in rheumatology books is of a mono- or oligoarticular disease. Children and young adults in endemic areas may be especially susceptible to a polyarticular presentation. Awareness of this pattern of illness might prevent similar cases of progressive, disabling illness. The ease of transcontinental travel makes it important that clinicians worldwide maintain a vigil for tuberculosis in obscure cases of polyarthritis deriving from geographic areas of risk.

Plain radiology and other imaging techniques

The incidence of radiological change in psoriatic arthritis (PsA) is uncertain. The general pattern of the disease has been classified into five groups. This classification is still widely used, but recently a change of emphasis has been stressed in the classification and prevalence, particularly relating to the polyarthritic forms and the variability of symmetry and asymmetry. The plain film findings in the axial and appendicular skeleton are described. In the former, bulky paramarginal ossification in the thoracolumbar spine is a prominent feature; destructive as well as ankylosing disease is seen in the cervical spine. In the latter, the key features are marginal erosions associated with proliferative new bone, acro-osteolysis, preservation of bone density, periostitis and bony ankylosis. Progress of the disease is variable and, while the course is usually less severe than that in rheumatoid arthritis, progressive joint deformity occurs. Isotope scintigraphy is a useful technique for showing a general overview of joint involvement, but has limitations which impair its use in individual joints. CT is useful for looking at detailed bone anatomy and early demonstration of sacroiliitis. MRI may also be used to look at early sacroiliitis and has the potential for directly imaging the inflammatory process and the articular cartilage. Radiological differentiation of PsA from other arthritides may be difficult, particularly in the early stages, and in oligoarticular disease. The differential diagnosis is discussed.

Clinically silent infections in patients with oligoarthritis: results of a prospective study.

Oligoarticular synovitis of undetermined origin can closely resemble an incomplete form of reactive arthritis/Reiter's syndrome. Eighty three patients with oligoarthritis of undetermined origin were studied prospectively to identify asymptomatic infections potentially triggering the inflammatory response in the synovial fluid. At the time of initial evaluation, 57 (69%) of the patients with oligoarthritis and 4/20 (20%) of the control subjects were carriers of clinically silent infections. Evidence for persistent or prior chlamydial infections was frequently and exclusively found in the study group (30/83 (36%) patients v no controls), whereas undetected urogenital infections with mycoplasma were present in nine (11%) patients and four (20%) controls. Eleven (13%) of the patients carried cellular and humoral responses to Borrelia burgdorferi. The HLA-B27 haplotype represented a major risk factor for the development of oligoarthritis but not for development of sacroiliitis. Re-evaluation after one year showed that the course and outcome of the oligoarticular disease did not correlate with a specific infectious organism and were not affected by antibiotic treatment sufficient to treat the carrier state.

Incidence of arthritis in urban Finnish children. A prospective study.

The incidence of various types of arthritis in children was estimated by a prospective 1-year study in the greater Helsinki area (population under 16 years of age: 148,362). Patients were sought from primary care physicians, and 71% of the patients studied were seen within 1 week of the onset of symptoms. All patients received followup care for at least 3 months; patients whose symptoms were prolonged received followup care for a minimum of 2 years. The incidence per 100,000 children under 16 years of age was as follows: 108.5 for all cases of arthritis, 6.7 for septic arthritis, 5.4 for enteropathic arthritis, 51.9 for transient synovitis of the hip, 18.9 for prolonged arthritis (duration greater than 3 months), and 25.8 for acute transient arthritis. The incidence of juvenile rheumatoid arthritis was 19.6. Oligoarticular disease was prevalent (76%) among the juvenile rheumatoid arthritis patients.