What is polyarthritis and why is it so?

Polyarthritis just describes symptoms - inflammation in multiple joints, with pain, swelling and stiffness. These may need relief, but the underlying disease may need treatment to protect other parts of our body as well.

Haemochromatosis is the first condition to consider, as it is commonly missed to the point when the joints or other organs are irreversibly damaged¹.

Here there is too much iron in the body. This mineral is essential for carrying oxygen to our cells and for using this to produce energy. It's a good example of the general principle that too much and too little are often just as deleterious.

Iron deficiency is probably the commonest deficiency worldwide and haemochromatosis is the most common autosomal recessive² disorder (in northern European populations.)

Symptoms include chronic fatigue, weakness, abdominal pain, joint pain - all things which can can have any number of causes.

A blood test for fasting transferrin saturation and ferritin is a worthwhile part of any checkup for such symptoms. Elevated transferrin saturation plus elevated ferritin exceeds the accuracy of either test alone.

Treatment is very simple if it is discovered early enough, nothing more than donating blood regularly to keep the iron level normal.

If this condition is diagnosed, it is really important for all family members to have tests done, whether or not they have symptoms.

Rheumatoid disease is more common, and again can be missed with unnecessary damage to joints occurring.

Symptoms include chronic fatigue, weakness, joint pain, malaise - sounds familiar? The symmetry of the arthritis and morning stiffness lasting at least an hour, can alert one's suspicions.

There is no blood test which gives a certain answer here. It is a clinical diagnosis mainly.

Joints can be irreversibly damaged early in the course of this disease, if effective treatment is delayed.

Treatment is detailed on the inflammatory arthritis page.

Gout can involve multiple joints. It's a male thing (at least till the female menopause) with urate being produced too rapidly and/or disposed of from our body too slowly.

This can involve any joint, but attacks usually follow injury, so the big toe is most often afflicted. The diagnsis here is usually pretty obvious, but the "gold standard" for diagnosing gout is the demonstration of urate crystals in synovial fluid or tissue samples.

Aspiration of fluid from an inflamed joint can be a crucially important measure to diagnose the cause of the inflammation. The pathologist looks for crystals in the fluid. These can stick to the sides of the container, so heparin should be added to prevent this giving a false negative result.

Treatment of acute attacks can be NSAID drugs such as indomethacin, colchicine (only 1-3 per day,) corticosteroids or the interleukin 1 inhibitor Anakinra.

It's best not to stop the treatment too early or the attack may resume where it left off. A reduced dose, say indomethacin 1 per day, is continued for 3 days after it seems to be better.

Prevention is usually with the drug allopurinol. This is considered if there are more acute attacks than one is prepared to put up with, there are definite X-ray changes, gouty tophi or a blood test with urate 0.6mmol/litre or more.

One has to "start low and go slow" with this drug, as it can produce acute attacks when started. Colchicine is usually given, 1 per day to prevent this, for the first 6-12 months.

Ankylosing spondylitis

is another predominantly male complaint with fatigue, joint pain, fever, weight loss as with rheumatoid. Back pain and morning stiffness are prominent here. This is an example of spondyloarthritis (affecting the spine.)

It is often in young men, comes on gradually over years. Pain and stiffness improve with exercise.

Standing upright with your back against a wall, have someone measure from your middle fingertip to the floor. This distance should be at least 10cm shorter if you run your hand down your thigh, bending fully to the side while keeping your back against the wall.
This is usually the first test to show the stiffness in AS.

Psoriatic arthritis involves limb joints more, rather than the spine. The skin disease psoriasis has usually been present for years before joints get involved, but sometimes only appears later.

Fingernail changes are often present, especially if DIP joints of fingers have the arthritis.

Nail changes include pitting, ridges, hyperkeratosis and onycholysis.

References and notes for polyarthritis page.

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114910/

2. Autosomal refers to genes on chromosomes other than the X and Y that determine gender. Recessive means that two copies of the particular gene mutation are needed to produce the full clinical picture (one on each of the pair of chromosomes.)

Return to home page from polyarthritis page.

Autosomal refers to a chromosome other than our "sex chromosomes" X and Y.

Recessive conditions are when one needs both copies of a particular problematic variation of a gene, to cause trouble.


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Gouty tophi are distinct hard lumps under the skin, usually around joints, made of urate crystals.

Our DIP (distal interphalangeal) joints are finger joints closest to the fingernails - distal means furthest away and the finger bones are called phalanges.

Pitting here refers to tiny pin-point pits, best seen with slanting light across the nail, especially significant if you can count >20 of them.

Hyperkeratosis - too much keratin, here means thickening of the nail itself - it is made of keratin.

Onycholysis is when the nail separates from the nailbed under it.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.