Scribd Logo
Upload

Welcome to Scribd!

  • 62 views

    2001 03 12 Acute Monoarthritis

    Uploaded by

    ZH. omg sar
    This document discusses acute monoarthritis, including its definition and most common causes. It outlines the important aspects of history, physical exam, diagnostic tests, treatment, and when to refer a patient. Infection, crystals, trauma, and systemic rheumatic diseases are among the most common causes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    2001 03 12 Acute Monoarthritis

    Uploaded by

    ZH. omg sar
    62 views14 pages
    This document discusses acute monoarthritis, including its definition and most common causes. It outlines the important aspects of history, physical exam, diagnostic tests, treatment, and when to refer a patient. Infection, crystals, trauma, and systemic rheumatic diseases are among the most common causes.

    Original Description:

    medicine

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses acute monoarthritis, including its definition and most common causes. It outlines the important aspects of history, physical exam, diagnostic tests, treatment, and when to refer a patient. Infection, crystals, trauma, and systemic rheumatic diseases are among the most common causes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    62 views14 pages

    2001 03 12 Acute Monoarthritis

    Uploaded by

    ZH. omg sar
    This document discusses acute monoarthritis, including its definition and most common causes. It outlines the important aspects of history, physical exam, diagnostic tests, treatment, and when to refer a patient. Infection, crystals, trauma, and systemic rheumatic diseases are among the most common causes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 14

    © 2003-2006, David Stultz, MD

    Acute Monoarthritis

    David Stultz, MD
    March 12, 2001
    AAFP 1996;54:2239-43
    © 2003-2006, David Stultz, MD

    Acute Monoarthritis
    • Inflammatory Process involving a single
    joint
    • Develops over a few days
    • Any rheumatic disease can present as
    monoarthritis
    • Monoarthritis is not the initial symptom of a
    systemic connective tissue disease
    © 2003-2006, David Stultz, MD

    Most Common Causes


    • Infection
    • Crystals
    – Monosodium urate
    – Calcium pyrophosphate dihydrate
    – Basic calcium phosphate
    • Trauma and Overuse
    • Systemic rheumatic disease
    – Rheumatoid arthritis
    – Seronegative spondyloarthritis
    © 2003-2006, David Stultz, MD

    History
    • History of previous joint problem
    • History of osteoarthritis
    • Timing of onset
    – Rapid – Trauma with mechanical problem
    – Hours-week – Infection or Crystal arthritis
    • Hours-days – Gout
    • Several Days – Pseudogout
    – Longstanding – OA with mechanical or crystal
    problem
    – Weeks-Months – Inflammatory Arthritis (eg Reiters or
    spondyloarthropathy
    © 2003-2006, David Stultz, MD

    History

    • Migratory Pattern – GC or Rheumatic


    Fever
    • Erythema most common with infection or
    crystal arthritis
    • Desquamation of skin – Gout
    • Monoarthritis vs Oligoarthritis (<5 joints)
    • Risks for Lyme disease, HIV
    © 2003-2006, David Stultz, MD

    Physical Exam
    • Articular vs Periarticular pain
    – Articular problems cause active and passive
    range of motion restriction
    – Periarticular problems restrict active range
    more than passive range of motion
    • Inflamed joint
    – Most sensitive test – stress pain (pain at
    extreme range of motion)
    – Most specific test – Joint effusion
    © 2003-2006, David Stultz, MD

    Extra-Articular Features

    • Reiter’s Syndrome – Urethritis, conjunctivitis, diarrhea, rash


    • Psoriatic Arthritis – Psoriatic skin rash, pitting nails
    • Gouty Arthritis – Diuretics, tophi, renal stones
    • Ankylosing spondylitis – Uveitis, low back pain
    • Sarcoidosis – Hilar adenopathy, erythema nodosum
    • GC – Tenosynovitis, pustules, sexual hx
    • Coagulopathy – Bleeding tendency, anticoagulants
    • Avascular necrosis – SLE, steroids, Alcohol
    • Septic Arthritis – Immunosuppression, IV drugs, abnormal joint
    © 2003-2006, David Stultz, MD

    Joint Aspiration
    • Color
    – Can read newsprint through normal synovial fluid
    • WBC with differential
    – WBC’s, neutrophils increased in infection
    • Crystal analysis
    – Monosodium urate – needle shaped, (-) birefringent
    – Calcium pyrophosphate dihrdrate – rhomboid, (+)
    birefringent
    • Gram stain and culture
    © 2003-2006, David Stultz, MD

    Interpretation of Synovial fluid


    • WBC/mm3
    – <200 – normal
    – <2,000 – noninflammatory
    – 2,000-20,000 – Mild (SLE)
    – 20,000-50,000 – Moderate
    • Rheumatoid Arthritis
    • Reactivie Arthritis
    – >50,000 – Severe (Sepsis, Gout)
    © 2003-2006, David Stultz, MD

    Labs
    • CBC, blood culture (optional)
    • Uric acid – not always helpful
    • Xray – chondrocalcinosis, fracture
    • MRI, CT, technetium bone scan
    © 2003-2006, David Stultz, MD

    Treatment
    • Rest, Ice, Range of Motion
    • Antibiotics for bacterial arthritis
    • NSAIDS +/- intra-articular steroids for
    noninfectious inflammatory arthritis
    • Arthroscopy for internal derangement
    • If uncertain dx then empiric abx and reaspiration
    in 24 hours is appropriate
    • If high suspicion for septic arthritis, treat with IV
    abx, ortho consult
    © 2003-2006, David Stultz, MD

    Antibiotic Therapy
    • Normal Host – Gram (+) organisms (including
    MRSA and Strep)
    • Immunocompromised – Gram (-) Bacteria
    • Gonococcal Arthritis – Ceftriaxone
    • Drain all septic joints at least q24h
    © 2003-2006, David Stultz, MD

    Monoarthritis

    History Extra-Articular Features

    Physical Exam

    Inflammatory Non-Inflammatory

    Joint Aspiration Radiograohy

    Infection Crystals Unclear Aspiration and Injection

    Antibiotics, Consult Treat with NSAIDS Treat Infection, Consult


    © 2003-2006, David Stultz, MD

    When to Refer
    • Unable to aspirate a suspected septic joint
    • Deep septic joints (hip, sacroiliac)
    • Uncertain inflammatory etiology
    • Persistent monoarthritis not responding to
    initial therapy
    • Extra-articular features suggesting a
    systemic connective tissue disease

    You might also like