Difference between revisions of "Monoarticular arthritis"

(Created page with "==Septic Arthritis== === === ===Gonococcal Arthritis=== Healthy, young sexually active adults Women > men Suppurative monoarthritis (may be preceded by polyarthralgias...")
 
 
(31 intermediate revisions by 6 users not shown)
Line 1: Line 1:
==Septic Arthritis==
+
==Background==
  
 +
==Clinical Features==
  
=== ===
+
==Differential Diagnosis==
 +
{{Differential Diagnosis Monoarthritis}}
  
 +
===[[Septic Arthritis]]===
 +
*[[Gonococcal arthritis]]
 +
*Nongonococcal Arthritis
 +
*Arthritis-Dermatitis Syndrome
  
===Gonococcal Arthritis===
+
===Crystal-Induced Monoarthritis===
 +
*[[Gout]]
 +
*[[Pseudogout]]
  
 +
===Traumatic===
 +
*[[Fracture]]
 +
*Ligamentous injury
 +
*Overuse
  
Healthy, young sexually active adults
+
===Ischemic===
 +
*[[Avascular necrosis]]
 +
*[[Decompression sickness]]
 +
*Spontaneous osteonecrosis
 +
**pain in absence of trauma
 +
**femoral head, medial conyle of knee
  
Women > men
+
===Hemorrhagic===
 +
*Posttraumatic
 +
*[[Hemophilia]]
 +
*Systemic [[anticoagulation]]
  
+
===Neoplastic===
 +
*Metastases
 +
*Osteochondroma
 +
*Osteoid osteoma
 +
*Pigmented villonodular synovitis
  
Suppurative monoarthritis (may be preceded by polyarthralgias)
+
===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]]
  
Knee, wrist, ankle
+
===Periarticular (mimic joint involvement)===
 +
*[[Cellulitis]]
 +
*Tendonitis
 +
*[[Bursitis]]
  
   
+
===Pediatric===
 +
*[[Transient (Toxic) Synovitis (Hip)]]
 +
*[[Slipped Capital Femoral Epiphysis (SCFE)]]  
 +
*[[Legg Calve Perthes Disease]]
  
Arthritis-Dermatitis Syndrome
+
==Evaluation==
  
-Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes)
+
==Management==
  
-Skin lesions: scattered small painless erythematous macules or petechiae-->pustular -->necrotic lesions
+
==Disposition==
  
-Transient painful extensor tenosynovitis (writs, hands, ankles)
+
==See Also==
 +
*[[Pseudogout]]
 +
*[[Gout]]
 +
*[[Septic Arthritis (Hip)]]
 +
*[[Septic Arthritis (General)]]
 +
*[[Arthritis]]
  
-Asymmtric polyarthralgia of extremity joints
+
==References==
 
+
<references/>
DiagnosisCx everything - jt, mucosal surfaces, lesions
+
[[Category:Orthopedics]]
 
+
[[Category:Rheumatology]]
TreatmentCTX 1gIV qd OR
+
[[Category:Symptoms]]
 
 
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==
 
 
 
 
 
=== ===
 
 
 
 
 
===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: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