Multi-system Disease
Musculoskeletal symptoms are common in multisystem disease. These may present as true inflammatory arthritis, often affecting multiple joints in a symmetrical pattern; arthralgia, where joints are painful but not visibly swollen; and myalgia (muscle pain) or myositis (muscle pain with tenderness and weakness).
These features may occur alongside systemic symptoms, including malaise and fatigue, weight loss, fever and rash.
These findings may indicate underlying connective tissue or inflammatory condition, such as:
- Juvenile systemic lupus erythematosus
- Juvenile dermatomyositis
- Vasculitis
- Scleroderma
- Periodic (autoinflammatory) syndromes
However, it is important to remember that the differential diagnosis also includes serious conditions, particularly infection and malignancy.
In addition, some chronic diseases may develop musculoskeletal features over time, including inflammatory bowel disease, metabolic conditions and genetic syndromes.
Clinical approach
Diagnosis relies on careful clinical assessment, supported by targeted investigations and appropriate specialist referral where required.
The photograph below shows skin vasculitis
