Difference between revisions of "Monoarticular arthritis"

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

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