Monoarticular arthritis: Difference between revisions
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Revision as of 18:13, 11 June 2011
Septic Arthritis
Gonococcal Arthritis
Healthy, young sexually active adults
Women > men
Suppurative monoarthritis (may be preceded by polyarthralgias)
Knee, wrist, ankle
Arthritis-Dermatitis Syndrome
-Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes)
-Skin lesions: scattered small painless erythematous macules or petechiae-->pustular -->necrotic lesions
-Transient painful extensor tenosynovitis (writs, hands, ankles)
-Asymmtric polyarthralgia of extremity joints
DiagnosisCx everything - jt, mucosal surfaces, lesions
TreatmentCTX 1gIV qd OR
Cefotax 1g q8
Empirically treat Chlamydia
Nongonococcal Arthritis
Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly
-Hematogenous
-Contiguous
-Direct traumatic implantation
-Postop
CausesBacterial
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
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
Pediatric
- Acute Transient Synovitis
- Children 3-10yo
- 1-3 wks after viral illness
- Self-limited
- Slipped Capital Femoral Epiphysis (SCFE) (portly pubescent)
- Legg Calve Perthes Disease (young school-age children)
See Also
Source
H-N