Year: 2026 | Month: January | Volume: 16 | Issue: 1 | Pages: 65-70
DOI: https://doi.org/10.52403/ijhsr.20260108
Undifferentiated Inflammatory Arthropathy as Knee Pain and Swelling - Case Series
Dr. Ratul Das
Medical Officer, MD-Physical Medicine and Rehabilitation, Fellowship Musculoskeletal Ultrasound in Pain Medicine, District Hospital South Tripura, Santirbazar, India
Corresponding Author: Dr. Ratul Das
ABSTRACT
Introduction: Undifferentiated inflammatory arthropathy (UIA) characterized by inflammatory joint pain that does not meet the classification criteria for a specific rheumatic disease which is a diagnostic challenge in rheumatology. The diagnosis relies on combination of clinical evaluation, laboratory tests, and imaging studies to rule out other established arthropathies. It is essential to differentiate this condition from other causes of knee pain to avoid unnecessary treatments. This case series consists of three cases with atypical presentations of UIA highlighting the complexities in distinguishing the condition from more definitively classified rheumatic diseases and management.
Case Description: The case series represents three patients suffering from knee pain with swelling for more than 3 months duration, having great difficulty in bending knee, walking, climbing stairs etc. On clinical examination, patellar tap test was positive suggestive of effusion in knee joint. Rheumatoid factor, total Leukocyte count, C-reactive protein, uric acid, anti-cyclic citrullinated peptide was normal but erythrocyte sedimentation rate (ESR) was markedly high which was an indication of nonspecific inflammation. Ultrasonography of knee joint showed the presence of joint effusion and power doppler was indicating increase in blood flow within synovium suggestive of inflammatory type of arthropathy. They didn't meet any standard diagnostic criteria and diagnosed as undifferentiated inflammatory arthropathy. These patients were treated with DMARDS like Methotrexate, Sulfasalazine and intra-articular knee joint injection procedure using Triamcinolone acetonide. All three cases were reviewed after three months of treatment initiation and had excellent improvement in pain and functional parameters without knee joint effusion. Visual Analogue Scale score and Western Ontario and McMaster Universities Osteoarthritis Index score were markedly improved. All three cases were found to sustain their improvement at sixth month of follow-up.
Conclusions: Clinical picture, inflammatory marker like ESR and power doppler study is helpful in diagnosis of undifferentiated inflammatory arthritis and early management with DMARDS and intra-articular steroid is key to treat these patients to minimize disability.
Key words: UIA, ESR, DMARDS