This slideshow illustrates different types of arthritis featured in cases from the Consultant archives. Each slide links to the full case report for more details.
Systemic Onset Juvenile Idiopathic Arthritis
A 12-month-old girl presented to the emergency department with 10-day history of fever and a waxing and waning polymorphous rash (A). On arrival, her temperature was 37.9°C (100.3°F), heart rate was 175 beats per minute, respiratory rate was 32 breaths per minute, and oxygen saturation was 99% on room air. Physical examination revealed a generalized, macular, blanching, erythematous rash. The girl did not appear toxic, and no evidence of organomegaly or serositis was present.
Results of a complete blood count showed leukocytosis, with neutrophilia and thrombocytosis. The C-reactive protein (CRP) level was elevated at 75 mg/L, and the erythrocyte sedimentation rate was elevated at 90 mm/hour.
Acute Gouty Arthritis
A 56-year-old man who consumed moderate amounts of alcohol was awakened by an intense burning pain in the right great toe; local erythema and edema were also present. Within hours, the pain became excruciating, and the same symptoms developed in the left great toe. Acetaminophen provided no relief. The patient's serum uric acid level was 8.8 mg/dL.
Acute gouty arthritis of the first metatarsophalangeal joints, or podagra, was diagnosed. Common precipitants of acute attacks include excess alcohol intake, trauma, surgery, intercurrent illness, starvation, overindulgence in foods with a high purine content, and the use of drugs that alter urate metabolism.
Atraumatic Cervical Fracture in Rheumatoid Arthritis
A 72-year-old white woman with hypertension, hypothyroidism, breast cancer (in remission), and monoclonal gammopathy of undetermined significance (MGUS) presented with a sore throat and sinus congestion of 1-month duration.
The patient had previously been seen at an urgent care clinic and was prescribed nasal fluticasone propionate as well as a 10-day course of cefuroxime, which did not help her symptoms. During the visit, she complained of “full sinuses,” sore throat, and mild right-sided neck discomfort. She had been using a Neti pot without relief. She denied any fevers, tooth pain, anosmia, or rhinorrhea.
Presentations of Arthritis