November 8, 2021

Understanding Migratory Polyarthritis

Written by: Amanda Cheong, M.D.

We call out “arthritis” whenever there’s something off with our joints. Perhaps, it’s painful. Sometimes, stiff. Joints would snap, creak and crunch, as if there were small stones stuck in an otherwise well-maintained machine. But in reality, there are as much as a hundred different types of arthritis, each with its specific causes and treatments.[1]

 

There is the most common, osteoarthritis, which affects 10% of men and 13% of women above the age of  60.[2] There is gouty arthritis which often affects men who have just gone on a drinking binge. Rheumatoid arthritis is seen more in women with autoimmune conditions. Septic arthritis. Psoriatic--- [1]

 

You get the drift.

 

But there is a way in which healthcare practitioners make sense of a hundred different types of joint problems. They have their own language for succinctly describing how these arthritis manifests. Then, at the end of this classification system are the likely disease suspects. No, they don’t always neatly fit into discrete boxes-- but this organization system certainly helps.

 

Making sense of arthritis

 

They usually start with how long it’s been since the problem started. Then, they move on to the number of joints involved-- monoarticular if it’s only one and polyarticular (or a polyarthritis) if it’s more than one. Does it only happen on one side or is the problem mirrored symmetrically on the other? Which joints does it affect? Does it go after large ones like the knees and hips or is it partial to the small joints of an older woman’s hands? Some arthritis have a progressive additive pattern where new painful and stiff joints are added to a growing list. Others have a migratory pattern where the arthritis gets better in one joint only to hop on to the next.[1]

 

So when we put together the term migratory polyarthritis, we’re not talking about a specific disease. Instead, this is a way to describe a specific pattern of arthritis-- where the symptoms, be it pain or stiffness or perhaps being warm and red, seen in several joints would move from one joint to another. And, in fact, there are several diseases that can be attributed to this specific description.

 

Acute Rheumatic Fever

 

One of the first causes of migratory polyarthritis that comes to mind is acute rheumatic fever. This normally comes around two weeks to a month after catching a strep throat and comes with a host of other symptoms, though the migratory polyarthritis is the most often cited complaint. Besides arthritis, people with this disease can experience fever, heart problems, certain involuntary movements called Sydenham chorea, and lesions on the skin.[3] For patients who do not satisfy all the criteria for acute rheumatic fever but have a recent strep infection, they may have post-streptococcal reactive arthritis instead and manifest similarly.[4]

 

Migratory polyarthritis tends to be the earliest manifestation of acute rheumatic fever and is more severe in teenagers and young adults. For those with the disease, the pain and stiffness in the joints can come one after the other in rapid succession. First the ankles, then the knees in less than a week-- just as your ankles start feeling better. Then it goes up to the elbows. The wrists. It hops to the next victim just as the inflammation on the last is starting to fade away. The arthritis can be severe enough to limit movement and hamper day to day functioning-- even if the x-rays of the affected joint look mild relative to the symptoms.[5]

 

The good thing is that the migratory polyarthritis of acute rheumatic fever responds rather quickly to certain over the counter pain relievers. Specifically, I’m talking about the non-steroidal anti-inflammatory drugs or NSAIDs which include ibuprofen or naproxen. Taking the medicine would help ease symptoms and its migration through your joints in around two days. If it doesn’t, you might be looking at the wrong disease.[4] Hence why it’s always important to consult with your healthcare providers on symptoms such as these.

 

Related Article: What is Viral Arthritis?

Gonococcal Arthritis

 

This type of arthritis is caused by the spread of the bacteria Neisseria gonorrhoeae. Yes, this is the sexually transmitted infection that causes gonorrhea and this arthritis affects around 3% of people who have the STI. When it leaves the confines of the reproductive organs and travels through the bloodstream, this can seed into different areas including the joints.[6]

 

This disease is classically composed of three symptoms-- skin rashes, pain in the lining of tendons (often felt in the wrists, fingers, ankles, and toes), and migratory polyarthralgia. The kind of arthritis this has can affect both the large joints, like your knees and elbows, as well as the smaller joints in your hands. They also tend not to appear symmetrically-- more of a spattering of arthritis all over than something with a pattern. A person with this type of gonorrhea can also experience fevers and chills.[6]

 

In patients with this kind of arthritis, the antibiotics given aren’t commonly taken by mouth. Your provider may need to have you admitted in order to administer antibiotics straight to your bloodstream or injected into your muscle. The antibiotic treatment is especially important since joint symptoms are often only found when the bacteria has already entered the bloodstream. And because this is an STI, partners of patients being treated for gonococcal arthritis should be contacted and treated as well.[6]

 

Other causes of migratory polyarthritis

 

As there are a hundred different types of arthritis, we barely exhausted the full list of causes of migratory polyarthritis. This pattern of arthritis can be seen in lyme disease especially early on in the illness-- though this usually only lasts a few hours or days before the pain hops to another joint.[7] Systemic Lupus Erythematosus can also cause this migratory pattern of arthritis, mimicking the appearance of acute rheumatic fever.[8] It may even be a rare adverse effect of taking commonly prescribed drugs such as clopidogrel-- though this symptom resolves once the medication is discontinued.[9]

 

Most of these diseases are not easy or safe to remedy at home. But now that you know the language of how to classify these arthritis and what it feels like to have migratory polyarthritis, it could be easier to have the vocabulary to explain to your healthcare provider what you’re feeling. This would help them figure out how best to diagnose and then treat this disease.

 

References:

  1. Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/
  2. Zhang Y, Jordan JM. Epidemiology of osteoarthritis [published correction appears in Clin Geriatr Med. 2013 May;29(2):ix]. Clin Geriatr Med. 2010;26(3):355-369. doi:10.1016/j.cger.2010.03.001
  3. Shortell JD, Sato R, Riangwiwat T, Olalia M, Chong CM. Overlooking Recurrent Acute Rheumatic Fever in Adulthood. Hawaii J Health Soc Welf. 2019;78(9):293-296.
  4. Bawazir Y, Towheed T, Anastassiades T. Post-Streptococcal Reactive Arthritis. Curr Rheumatol Rev. 2020;16(1):2-8. doi:10.2174/1573397115666190808110337
  5. FEINSTEIN AR, SPAGNUOLO M. The clinical patterns of acute rheumatic fever: a reapraisal. Medicine (Baltimore). 1962;41:279-305. doi:10.1097/00005792-196212000-00001
  6. Li R, Hatcher JD. Gonococcal Arthritis. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470439/
  7. Steere AC. Musculoskeletal manifestations of Lyme disease. Am J Med. 1995;98(4A):44S-51S. doi:10.1016/s0002-9343(99)80043-6
  8. Ajmani, S., Misra, D. P., & Lawrence, A. (2018). Sle presenting as migratory arthritis, chorea and nephritis. Mediterranean Journal of Rheumatology, 29(1), 43–45. https://doi.org/10.31138/mjr.29.1.43
  9. Ayesha B, Varghese J, Stafford H. Clopidogrel-Associated Migratory Inflammatory Polyarthritis. Am J Case Rep. 2019;20:489-492. Published 2019 Apr 10. doi:10.12659/AJCR.911598
Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

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