Monoarticular arthritis: Difference between revisions

Revision as of 01:12, 24 July 2017

Background

Clinical Features

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

Acute osteoarthritis
Avascular necrosis
Crystal-induced (Gout, Pseudogout)
Gonococcal arthritis, arthritis-dermatitis syndrome
Nongonococcal septic arthritis
Lyme disease
Malignancy (metastases, osteochondroma, osteoid osteoma)
Reactive poststreptococcal arthritis
Trauma-induced arthritis
- Fracture
- Ligamentous injury
- Overuse
Avascular necrosis
Decompression sickness
Spontaneous osteonecrosis
Hemorrhagic (e.g. hemophilia, systemic anticoagulation
Seronegative spondyloarthropathies (ankylosing spondylitis, IBD, psoriatic arthritis, reactive arthritis
RA, SLE
Sarcoidosis, amyloidosis
Periarticular pathology
- Cellulitis
- Tendonitis
- Bursitis
Transient (Toxic) Synovitis (Hip)
Slipped Capital Femoral Epiphysis (SCFE)
Legg Calve Perthes Disease

Septic Arthritis

Gonococcal Arthritis
Nongonococcal Arthritis
Arthritis-Dermatitis Syndrome

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
Hemophilia
Systemic anticoagulation

Neoplastic

Mets
Osteochondroma
Osteoid osteoma
Pigmented villonodular synovitis

Systemic Disease

Remote infectionn, infectious endocarditis
Rheumatic fever
Seronegative (no RF) spondyloarthropathies (AS, IBS, psoriatic, reactive or Reiter's)
Rheumatoid arthritis, SLE
Sarcoidosis, amyloidosis

Periarticular (mimic joint involvement)

Cellulitis
Tendonitis
Bursitis

Pediatric

Evaluation

Management

Disposition

References

Authors:

@@ Line 1: / Line 1: @@
-==Septic Arthritis==
+==Background==
-===Gonococcal Arthritis===
-Healthy, young sexually active adults
-Women > men
+==Clinical Features==
-Suppurative monoarthritis (may be preceded by polyarthralgias)
-Knee, wrist, ankle
+==Differential Diagnosis==
+{{Differential Diagnosis Monoarthritis}}
-===Arthritis-Dermatitis Syndrome===
+===[[Septic Arthritis]]===
--Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes)
+*Gonococcal Arthritis
+*Nongonococcal Arthritis
+*Arthritis-Dermatitis Syndrome
--Skin lesions: scattered small painless erythematous macules or petechiae-->pustular -->necrotic lesions
+===Crystal-Induced Monoarthritis===
+*[[Gout]]
+*[[Pseudogout]]
--Transient painful extensor tenosynovitis (writs, hands, ankles)
+===Traumatic===
+*Fracture
+*ligamentous
+*Overuse
--Asymmtric polyarthralgia of extremity joints
+===Ischemic===
+*Avascular necrosis
+*Decompression illness
+*Spontaneous osteonecrosis
+*pain in abscence of trauma
+*femoral head, medial conyle of knee
-DiagnosisCx everything - jt, mucosal surfaces, lesions
+===Hemorrhagic===
+*Posttraumatic
+*Hemophilia
+*Systemic anticoagulation
-TreatmentCTX 1gIV qd OR
+===Neoplastic===
+*Mets
+*Osteochondroma
+*Osteoid osteoma
+*Pigmented villonodular synovitis
-Cefotax 1g q8
+===Systemic Disease===
+*Remote infectionn, infectious endocarditis
+*Rheumatic fever
+*Seronegative (no RF) spondyloarthropathies (AS, IBS, psoriatic, reactive or Reiter's)
+*Rheumatoid arthritis, SLE
+*Sarcoidosis, amyloidosis
-Empirically treat Chlamydia
+===Periarticular (mimic joint involvement)===
+*Cellulitis
+*Tendonitis
+*Bursitis
-===Nongonococcal Arthritis===
+===Pediatric===
-Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly
+*[[Transient (Toxic) Synovitis (Hip)]]
+*[[Slipped Capital Femoral Epiphysis (SCFE)]]
+*[[Legg Calve Perthes Disease]]
--Hematogenous
+==Evaluation==
--Contiguous
+==Management==
--Direct traumatic implantation
+==Disposition==
--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
-rd 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]]
-#[[Pseudogout]]
-==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==
-[[Pseudogout]]
+*[[Pseudogout]]
+*[[Gout]]
-[[Gout]]
+*[[Septic Arthritis (Hip)]]
+*[[Septic Arthritis (General)]]
-==Source==
+*[[Arthritis]]
-H-N
-[[Category:Ortho]]
+==References==
-[[Category:Rheum]]
+<references/>
+[[Category:Orthopedics]]
+[[Category:Rheumatology]]