Arthritis: Other cosmopolitan causes

• Acute rheumatic fever. Migrating arthritis of the major joints is an essential sign in this disease, which is frequent in tropical countries. It can occur several weeks after a throat infection with Lancefield group A streptococci, e.g. Streptococcus pyogenes. Subcutaneous noduli appear a few weeks after fever, carditis and sudden arthritis. Both erythema marginatum and noduli are rare (cfr Jones' criteria).

• Familial Mediterranean Fever. The disease was for a long time of unknown origin, but mutations have recently been identified in the gene coding for the protein marenostrine. Certain population groups such as Armenians and children of consanguineous marriages run a high risk of being affected. Attacks of acute abdominal pain as well as pleuritis and pericarditis occur. There is a considerable risk of amyloidosis as a complication. DNA-analysis can confirm the clinical suspicion in more than 70% of the cases (anno early 2004). Colchicine is used for prevention.

• Reiter syndrome can occur after unprotected sexual intercourse and is characterised by urethritis, conjunctivitis/iritis and arthralgia. A culture or better PCR should be carried out (detection of Chlamydia trachomatis and Neisseria gonorrhoea). PCR for Chlamydia trachomatis can also be performed on urine.

• Miscellaneous. Gout and pseudogout (calcium pyrophosphate) are cosmopolitan diseases. Autoimmune diseases, such as sarcoidosis, systemic lupus erythematosus and rheumatoid arthritis, including the juvenile form (Still’s disease). Henoch-Schönlein purpura is usually identified by the associated symptoms (abdominal pain, cutaneous rash, renal abnormalities). Do not forget tuberculosis and leprosy in cases of osteomyelitis.

Category: Medicine Notes