Monoarticular arthritis: Difference between revisions

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==Septic Arthritis==
==Septic Arthritis==
===Gonococcal Arthritis===
#Gonococcal Arthritis
Healthy, young sexually active adults
#Nongonococcal Arthritis
 
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==
==Crystal-Induced Monoarthritis==

Revision as of 20:07, 11 June 2011

Septic Arthritis

  1. Gonococcal Arthritis
  2. Nongonococcal Arthritis

Crystal-Induced Monoarthritis

  1. Gout
  2. Pseudogout

Traumatic

  1. Fracture
  2. ligamentous
  3. Overuse

Ischemic

  1. Avascular necrosis
  2. Decompression illness
  3. Spontaneous osteonecrosis
  4. pain in abscence of trauma
  5. femoral head, medial conyle of knee

Hemorrhagic

  1. Posttraumatic
    1. Joint aspiration if tense
    2. RICE
  2. Hemophilia
  3. Systemic anticoagulation

Neoplastic

  1. Mets
  2. Osteochondroma
  3. Osteoid osteoma
  4. Pigmented villonodular synovitis

Systemic Disease

  1. Remote infxn, infectious endocarditis
  2. Rheumatic fever
  3. Seronegative (no RF) spondyloarthropathies (AS, IBS, psoriatic, reactive or Reiter's)
  4. Rheumatoid arthritis, SLE
  5. Sarcoidosis, amyloidosis

Periarticular

these conditions mimic joint involvement...

  1. Cellulitis
  2. Tendonitis
  3. Bursitis

Pediatric

  1. Acute Transient Synovitis
    1. Children 3-10yo
    2. 1-3 wks after viral illness
    3. Self-limited
  2. Slipped Capital Femoral Epiphysis (SCFE) (portly pubescent)
  3. Legg Calve Perthes Disease (young school-age children)

See Also

Pseudogout

Gout

Septic Arthritis (Hip)

Septic Arthritis (General)

Source

H-N