Approach to polyarthritis
Is it inflammatory, how long has it lasted, and what pattern does it follow? Viral arthritis (parvovirus, Ross River) settles within weeks; persistent symmetric small-joint synovitis needs anti-CCP, RF and referral within 6 weeks so DMARDs start early.
Tier 1Approach to a presentation
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Three questions frame every case: is it inflammatory, how long has it lasted, and what pattern does it follow?
- Under 6 weeks: think viral (parvovirus B19, Ross River virus, hepatitis B), reactive arthritis, rheumatic fever and gonococcal infection.
- Persistent symmetric small-joint synovitis suggests rheumatoid arthritis. Check anti-CCP and RF at first presentation and refer early, without waiting for 6 weeks to pass: EULAR wants rheumatology review within 6 weeks of onset and DMARDs within 3 months.
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Sources
- Therapeutic Guidelines: RheumatologyAU/NZTherapeutic Guidelines Limited (eTG complete), current online version, accessed November 2026
- Combe B et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017;76:948-59EULAR, 2016 (current as of November 2026)
- Smolen JS et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs: 2025 update. Ann Rheum Dis 2026EULAR, 2025 (published March 2026)
- Aletaha D et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580-8ACR and EULAR, 2010
- The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition)AU/NZRHDAustralia (Menzies School of Health Research), 3rd edition, October 2026 update
- Ross River virus infection (Australian national notifiable diseases information)AU/NZAustralian Centre for Disease Control, online, accessed November 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy