Some Suggestive Findings in Polyarticular Joint Pain

General findings

Coexisting tendinitis

Rheumatoid arthritis, disseminated gonococcal infection, psoriatic arthritis, gout, juvenile idiopathic arthritis (when begins at age ≤ 16)

Conjunctivitis, diarrhea, skin and genital lesions

Reactive arthritis

Fever

Infectious arthritis, gout, systemic inflammatory disorders (eg, SLE, rheumatoid arthritis)

Malaise, weight loss, and lymphadenopathy

Acute HIV infection, systemic juvenile idiopathic arthritis (Still disease)

Oral and genital lesions

Behçet disease, reactive arthritis

Raised silver plaques

Psoriatic arthritis

Recent pharyngitis and migrating arthritis or severe arthralgia

Rheumatic fever, disseminated gonococcal infection

Recent vaccination or use of a blood product

Serum sickness

Skin lesions, abdominal pain, respiratory symptoms, and mucosal lesions

Systemic vasculitis

Urethritis

Reactive arthritis or disseminated gonococcal infection

Hand findings

Asymmetric involvement of PIP and DIP joints with diffuse swelling of fingers (dactylitis) and/or nail pitting

Psoriatic arthritis

Tophi plus asymmetric involvement of any hand joints, including acute inflammation of DIP (Heberden nodes) joints

Gout

Bony enlargement of the PIP (Bouchard nodes) or DIP (Heberden nodes) joints

First carpometacarpal (CMC) involvement

Osteoarthritis

Raynaud phenomenon

Systemic sclerosis, SLE, or mixed connective tissue disease

Scaling rash, often with plaque formation, over extensor surfaces of MCP and PIP joints (Gottron papules)

Dermatomyositis

Laxity of multiple finger tendons that can result in reducible finger deformities (Jaccoud arthropathy)

SLE

Symmetric involvement of PIP and MCP joints, particularly with swan-neck or boutonnière deformities

Rheumatoid arthritis

Thickening of the skin over the fingers (sclerodactyly) and flexion contractures

Systemic sclerosis