Monoarticular arthritis: Difference between revisions

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==Septic Arthritis==
==Background==
===Gonococcal Arthritis===
Healthy, young sexually active adults


Women > men
==Clinical Features==


Suppurative monoarthritis (may be preceded by polyarthralgias)
==Differential Diagnosis==
{{Differential Diagnosis Monoarthritis}}


Knee, wrist, ankle
===[[Septic Arthritis]]===
*[[Gonococcal arthritis]]
*Nongonococcal Arthritis
*Arthritis-Dermatitis Syndrome


===Crystal-Induced Monoarthritis===
*[[Gout]]
*[[Pseudogout]]


===Arthritis-Dermatitis Syndrome===
===Traumatic===
-Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes)
*[[Fracture]]
*Ligamentous injury
*Overuse


-Skin lesions: scattered small painless erythematous macules or petechiae-->pustular -->necrotic lesions
===Ischemic===
*[[Avascular necrosis]]
*[[Decompression sickness]]
*Spontaneous osteonecrosis
**pain in absence of trauma
**femoral head, medial conyle of knee


-Transient painful extensor tenosynovitis (writs, hands, ankles)
===Hemorrhagic===
*Posttraumatic
*[[Hemophilia]]
*Systemic [[anticoagulation]]


-Asymmtric polyarthralgia of extremity joints
===Neoplastic===
*Metastases
*Osteochondroma
*Osteoid osteoma
*Pigmented villonodular synovitis


DiagnosisCx everything - jt, mucosal surfaces, lesions
===Systemic Disease===
*Remote infection, infectious [[endocarditis]]
*[[Rheumatic fever]]
*Seronegative (no RF) spondyloarthropathies ([[ankylosing spondylitis]], [[IBD]], [[psoriatic arthritis|psoriatic]], [[reactive arthritis]])
*[[Rheumatoid arthritis]], [[SLE]]
*[[Sarcoidosis]], [[amyloidosis]]


TreatmentCTX 1gIV qd OR
===Periarticular (mimic joint involvement)===
*[[Cellulitis]]
*Tendonitis
*[[Bursitis]]


Cefotax 1g q8
===Pediatric===
*[[Transient (Toxic) Synovitis (Hip)]]
*[[Slipped Capital Femoral Epiphysis (SCFE)]] 
*[[Legg Calve Perthes Disease]]


Empirically treat Chlamydia
==Evaluation==


===Nongonococcal Arthritis===
==Management==
Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly


-Hematogenous
==Disposition==


-Contiguous
==See Also==
*[[Pseudogout]]
*[[Gout]]
*[[Septic Arthritis (Hip)]]
*[[Septic Arthritis (General)]]
*[[Arthritis]]


-Direct traumatic implantation
==References==
 
<references/>
-Postop
[[Category:Orthopedics]]
 
[[Category:Rheumatology]]
CausesBacterial
[[Category:Symptoms]]
 
Mycobacterial
 
Spirochete (lyme, syphilis)
 
Fungal
 
VIral (HIV, Hep B, Rubella, etc)
 
Postinfectious
 
DiagnosisSynovial fluid aspiration
 
Cx - if only one test, use BCx bottles (may enhance yield)
 
Grm stain - 80% positive in gram-positive infxn; less sens in gram-negative
 
Cell count with dif - >50,000-150,000; PMN > 90%
 
TreatmentPCN-ase resistant synthetic PCN:
 
Nafcillin 1-2g
 
Cefazolin 1-2g
 
AND
 
3rd gen ceph
 
OR
 
Vanc*
 
*new evidence suggests significantly increased rate of MRSA septic arthritis
 
**cell counts are as low as 20,000 in MRSA Cx + synovial fluid
 
==Crystal-Induced Monoarthritis==
===Gout===
Monosodium urate crystals - needle shaped negative birefringence
 
Swelling, redness, warmth evolving rapidly over hours todays
 
First MTP (podagra) 60% > ankle > midfoot > knee
 
May have constitutional complaints
 
Precipitants: purine-rich food, EtOH, trauma, chemo, diueretic use, RI
 
DiagnosisSynovial fluid aspiration (above)
 
Note: serum uric acid levels unhelpful; ESR/CRP may be elevated
 
TreatmentNSAIDS eg Naproxen 500mg po bid x 3d and taper over 4-7d
 
Colchicine 0.6mg po qh x 3 or 1mg PO f/b 0.5mg q1h until relif, GI upset, or 8mg max
 
Can give 1-2mg IV over 30mins
 
*No further doses after initial load
 
**avoid NSAIDS, Colchicine in RF
 
Steroids
 
-Prednisone 40-60mg po qd x 3d f/b 7d taper
 
===Pseudogout===
Calcium pyrophosphate dihydrate (CPPD) - rhomboid shaped positive birefringence
 
chondrocalcinosis
 
acute attacks of mono or oligoarticular inlammatory arthritis
 
progressive joint deenerative changes similar to OA
 
Evolves over days
 
Age > 50
 
Knee, wrists, ankles, elbows
 
Systemic illness, surgery, trauma triggers
 
Assoc with hyperparathyroidism and hemochromatosis
 
==Traumatic==
#Fracture
#ligamentous
#Overuse
 
==Ischemic==
#Avascular necrosis
#Decompression illness
#Spontaneous osteonecrosis
#pain in abscence of trauma
#femoral head, medial conyle of knee
 
==Hemorrhagic==
#Posttraumatic
##Joint aspiration if tense
##RICE
#Hemophilia
#Systemic anticoagulation
 
==Neoplastic==
#Mets
#Osteochondroma
#Osteoid osteoma
#Pigmented villonodular synovitis
 
==Systemic Disease==
#Remote infxn, infectious endocarditis
#Rheumatic fever
#Seronegative (no RF) spondyloarthropathies (AS, IBS, psoriatic, reactive or Reiter's)
#Rheumatoid arthritis, SLE
#Sarcoidosis, amyloidosis
 
==Periarticular==
these conditions mimic joint involvement...
#Cellulitis
#Tendonitis
#Bursitis
 
==Peds==
don't forget about...
#Acute Transient Synovitis
##Children 3-10yo
##1-3 wks after viral illness
##Self-limited
#SCFE (portly pubescent)
#Leff-Calve-Perthes (young school-age children)
 
==Source==
H-N   
 
[[Category:Ortho]]
[[Category:Rheum]]

Latest revision as of 23:48, 17 October 2019

Background

Clinical Features

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

Septic Arthritis

Crystal-Induced Monoarthritis

Traumatic

Ischemic

Hemorrhagic

Neoplastic

  • Metastases
  • Osteochondroma
  • Osteoid osteoma
  • Pigmented villonodular synovitis

Systemic Disease

Periarticular (mimic joint involvement)

Pediatric

Evaluation

Management

Disposition

See Also

References

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