Migratory arthritis (MA) is a pattern of joint inflammation that moves from one joint to another. The migratory pattern, where symptoms appear, resolve, and then reappear elsewhere, is a tell-tale sign of an underlying systemic process. This indicates that the cause is a disease affecting the entire body, with the joint symptoms being one manifestation of that larger condition. Identifying the cause of migratory arthritis requires looking beyond the joints to find the systemic trigger driving the inflammation.
Understanding the Shifting Pattern
The definition of migratory arthritis centers on the movement of symptoms across different joints. Unlike an additive pattern, where new inflamed joints join the already affected ones, MA is characterized by the resolution of inflammation in one joint before it appears in another. For instance, pain and swelling may develop in a knee, fully subside within a day or two, and then immediately emerge in an ankle or wrist. In a true migratory presentation, the inflammation is often described as “fleeting,” rapidly moving from one large joint to the next, such as the knees, ankles, elbows, and wrists, without causing permanent joint damage. The unpredictable nature of this shifting pain is the defining clinical feature that points physicians toward a systemic inflammatory or infectious cause.
Systemic Infections as the Primary Cause
Infectious agents are a common cause of acute migratory arthritis, often triggering an immune reaction that affects the joints. The mechanism is frequently reactive arthritis, where the body’s immune system, fighting off an infection elsewhere, mistakenly targets joint tissues. This immune response, rather than direct bacterial invasion, is responsible for the joint inflammation.
A classic example is Acute Rheumatic Fever (ARF), a serious complication of untreated Streptococcus pyogenes (strep throat) infection. The arthritis associated with ARF is highly migratory, often affecting the large joints in succession and typically resolving completely without lasting joint damage. The immune system produces antibodies against the strep bacteria that cross-react with proteins found in the joints.
Another highly migratory cause is Disseminated Gonococcal Infection (DGI), caused by the bacterium Neisseria gonorrhoeae. DGI frequently presents as migratory joint pain or frank migratory arthritis before potentially settling into a single, severely infected joint.
Lyme disease, caused by the tick-borne bacterium Borrelia burgdorferi, also commonly features migratory joint pain, particularly in its early stages. The joint inflammation is often a reaction to the persistent presence of the bacteria or bacterial components within the body.
Several viral infections also provoke migratory arthritis, including Parvovirus B19 and Hepatitis B and C. These viruses can induce immune complex deposition in the joint lining, which triggers inflammation that may be migratory. Reactive arthritis can also follow infections of the gastrointestinal or genitourinary tracts, with bacteria like Salmonella, Shigella, or Chlamydia trachomatis triggering the joint inflammation.
Autoimmunity and Inflammatory Conditions
Migratory arthritis is also a significant symptom in several chronic conditions where the immune system malfunctions, leading to autoimmunity and widespread inflammation. These diseases often require long-term management to control the shifting joint symptoms.
Systemic Lupus Erythematosus (SLE) is the most common autoimmune cause of MA. The arthritis associated with lupus is often migratory and involves the small joints of the hands and wrists, though it can affect any joint. In SLE, the body produces autoantibodies that form immune complexes, which deposit in the joint lining, causing inflammation.
Sarcoidosis, characterized by the growth of inflammatory cells (granulomas), can also present with migratory joint pain. A specific presentation known as Löfgren’s syndrome includes migratory ankle arthritis, along with tender, red nodules on the skin and enlarged lymph nodes in the chest.
Other inflammatory disorders, such as adult-onset Still’s disease, can manifest with a migratory pattern of joint inflammation, often accompanied by a high spiking fever and a characteristic rash. Additionally, inflammatory bowel diseases (IBD), like Crohn’s disease and ulcerative colitis, can cause enteropathic arthritis. This joint involvement is often migratory, affecting the large joints of the lower limbs, and is related to the underlying gut inflammation.