Seven masquerades checklist

• Depression—unlikely but complaints of arthralgia are possible

• Diabetes—occasionally causes an arthropathy

• Drugs—yes, a major consideration

• Thyroid disease—possible

• Spinal dysfunction—only with the spondyloarthropathies

Drug-induced arthritis is the main feature of this important group of disorders. It usually affects the hands and is generally symmetrical. Drugs that cause arthritis are listed in Table 31.2 .

Table 31.2 Drug-induced arthralgia

Commonest drugs inducing arthralgia

Note: Usually affects the hands and is symmetrical

Drugs inducing Lupus syndrome

• hydralazine

• procainamide

• antiepileptics, e.g. phenytoin

• chlorpromazine

• methyldopa

Others

• co-trimoxazole

• amoxycillin

• carbimazole

• nitrofurantoin

• antihypertensives

Note: Diuretics, especially frusemide and thiazides, can precipitate gout.

Intravenous drug abuse may be associated with septic arthritis, hepatitis B and C, HIV-associated arthropathy, SBE with arthritis and serum sickness reactions.

Hyperthyroidism can uncommonly cause acropathy (clubbing and swelling of the fingers) and may present as pseudogout, while hypothyroidism can present with an arthropathy or cause proximal muscle pain, stiffness and weakness. Diabetes mellitus may cause an arthropathy that can be painless or mild to moderately painful.

The spondyloarthropathies may be a causative factor. They often present with an acute monoarthritis particularly in teenagers some time before causing sacroiliitis and spondylitis.

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