Acute monoarthritis can be the initial manifestation of many joint. It may be a large weightbearing joint, or a smaller joint such as an interphalangeal joint, the great toe metatarsalphalangeal joint, or an elbow. Nov 21, 2016 gonococcal arthritis is the most common type of nontraumatic monoarthritis in young, sexuallyactive young adults. Acute monoarthritis should be considered infectious until proven otherwise. When dealing with a single joint location, need to check to make sure it is actually arthritis, as you need to consider the following. If acute monoarthritis is apparent from the history and physical examination the most common differential diagnoses are infectious arthritis, crystalinduced arthritis and traumainduced arthritis 3 fig. What is your general approach to a patient with acute monoarthritis. Jan 11, 2017 acute monoarthritis is joint inflammation arthritis of one joint. May 30, 2000 acute monoarthritis should be considered infectious until proven otherwise. Gonococcalseptic arthritis gonococcal arthritis mainly affects young adults with a threefold higher incidence in women. It is important to understand the prevalence of specific etiologies and to use the appropriate diagnostic modalities.
This article will give an overview of the approach to diagnosis, symptoms, underlying causes and other information related to this painful condition. Warning signs include a fever, laboratory evidence of inflammation, and leukocytosis. Polyarticular conditions can present initially with a single inflamed joint. Classification of arthritis by numberof joints involved 1. We aimed to identify the frequency of coexistence of ca with sa and to compare these with regard to synovial fluid microscopy, creactive protein crp, and blood culture. Approach to monoarticular arthritis clinical pearls. Infection, trauma, and crystalinduced arthritis for example, gout, pseudogout are the most common causes of monoarthritis. His symptoms had suddenly occurred two days before at night after he had gone to bed feeling well. Gout can cause mono or polyarthritis, but usually results in monoarthritis first. Gonococcal arthritis is the most common type of nontraumatic monoarthritis in young, sexuallyactive young adults.
The first step in diagnosis is to verify that the source of pain is the joint, not the surrounding soft tissues. We report four children who presented with severe isolated arthritis of the hip, wrist or elbow and were diagnosed with oligojia. Common causes of monoarthritis are infection, trauma and crystalinduced synovitis. Our aim is to offer an outline of how to assess, investigate, and manage a patient with. There was no history of joint disease or joint surgery. Approach to a child with monoarthritis springerlink. Dec 21, 2019 the evaluation of joint pain, both in terms of the history and the physical examination findings, is best achieved through an understanding of the basic pathophysiologic types of joint disease. Assessment, investigation, and management of monoarthritis.
The physical exam can help you clinch many of the diagnoses on your list if you look for other systemic manifestations that can be associated with these diagnoses we went through a few spotter style cases which ive attached in a powerpoint. Concomitant septic arthritis in crystal monoarthritis article pdf available in the journal of rheumatology 391. The most common presentation is acute monoarthritis of a hip, knee, shoulder, or sternoclavicular joint. Acute monoarthritis of the knee, shoulder, or hip can present a picture suggesting a septic, pseudogout, or gouty process, although this finding is rare. The first step in diagno sis is to verify that the source of pain is the joint, not the surrounding soft tissues. It often affects the knee and is characterized by systemic symptoms of sepsis e. Dr mcgill is a clinical associate professor in the department of medicine at the university of sydney and a consultant rheumatologist at royal prince alfred hospital. A detailed history and clinical examination is important to reach a correct diagnosis and. While monoarthritis is usually associated with an acute condition, it also can be the initial symptom of what develops into a polyarthritis or chronic type of arthritis. Acute monoarthritis is characterised by pain and swelling of a single joint. Monoarticular arthritis, monoarthritis, monoarticular joint pain, acute monoarthritis. Gout can cause mono or polyarthritis, but usually results in. Monoarticular arthropathy can result from a number of causes. The evaluation of joint pain, both in terms of the history and the physical examination findings, is best achieved through an understanding of the basic pathophysiologic types of joint disease.
Acute monoarthritis is characterised by pain and swelling of a single. There are a number of causes, with crystals, trauma and infection being the most common. The full text of this article is available as a pdf 226k. In acute monoarthritis, the presence of crystals in synovial fluid may lead to a diagnosis of crystal arthritis ca before septic arthritis sa can be excluded by culture. Diagnosing acute monoarthritis the diagnosis of acute monoarthritis begins with a comprehensive history and physical examination to reveal potential diagnostic clues3,6,17 table 21,3,6,12,18,19. Acute monoarthritis dt deposits of monosodium urate msu crystals in joints and tendons. However, in a significant minority of patients there will be no history of trauma and consequently a different approach to assessment and investigation is required. The history and physical exam typically reflect the acute presentation of a painful, restricted joint.
Nov 15, 2016 acute monoarthritis can be the initial manifestation of many joint disorders. Monoarthritis must be regarded as potentially septic until proven otherwise. Monoarthritis refers to the effects of arthritis being felt in one particular joint. Up to 20% of patients presenting with acute knee monoarthritis progress to develop ra tenaka et al. Oligoarticular juvenile idiopathic arthritis oligojia, the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Acute monoarthritis can be the initial manifestation of many joint disorders. Joint pain more severe than that found in ra is characteristic of pseudogout or gout, which may resemble or even complicate ra. Bursitis and tendinitis can present in a similar manner so it is important to establish that the problem is within the joint. Pitfalls in the diagnosis and early treatment of acute monoarthritis.
Joel yaphe, university of torontos emergency medicine residency program director and dr. The organism is identified in the joint aspirate in 50% to 70% of cases. Concomitant septic arthritis in crystal monoarthritis the. Acute monoarthritis with associate professor neil mcgill, consultant rheumatologist at royal prince alfred hospital 1. Undertake an audit of 510 patients presenting with acute monoarthritis and assess the approach to diagnosis and management gout and monoarthritis acute monoarthritis has numerous causes, but most commonly is related to crystals gout and pseudogout, trauma and infection. A careful history and physical examination are important because diagnostic studies frequently are. Acute monoarthritis describes the acute onset of arthritis affecting a single joint. Comparison of parenteral adrenocorticotropic hormone with oral indomethacin in the treatment of acute gout.
The code is valid for the year 2020 for the submission of hipaacovered transactions. In gout, the acute inflammatory arthritis is caused by excess uric acid caused by either overproduction or underexcretion. It also can be caused by a noninflammatory joint condition, periarticular condition i. Synovial fluid examination is the most important investigation. The pattern, presentation and duration of arthritis help differentiate between the various possible diagnoses. Before the age of menopause, women have a lower incidence than males, but the rates are equal above this age. A group of adult patients with acute nontraumatic monoarticular arthritis was studied.
These include synovitis, enthesopathy, crystal deposition, infection, and structural or mechanical derangements. Msu is a very potent activator of the innate immune system il1 is released recruits inflammatory cells. May 30, 2000 the full text of this article is available as a pdf. The full text of this article is available as a pdf. An accurate diagnosis of acute monoarthritis depends on a good history and physical. This page includes the following topics and synonyms. Using only the traditional clinical tools of history, physical examination, joint xray films, and synovial fluid culture, grams stain, and examination for crystals, 74% of the diagnoses made were achieved either. The most common causes of monoarthritis are crystals i. James talks to associate professor neil mcgill about the management of acute monoarthritis on the wards. Investigation of acute monoarthritis summary radiology.
Acute monoarthritis inflammatory process involving a single joint develops over a few days any rheumatic disease can present as monoarthritis monoarthritis is not the initial symptom of a systemic connective tissue disease. Monoarthritis definition of monoarthritis by medical dictionary. Assessment, investigation, and management of acute monoarthritis. Atypical monoarthritis presentation in children with. Pdf concomitant septic arthritis in crystal monoarthritis. A 77 year old retired man presented in a wheelchair to the emergency department with severe, constant pain and progressive swelling of the left knee. This is a basic article for medical students and other nonradiologists. Indy ghosh discuss the difficult diagnostic dilemmas when faced with a patient with acute monoarthritis. Diagnosing acute monoarthritis in adults semantic scholar. Acute monoarthritis symptoms and causes verywell health. Jan, 2017 oligoarticular juvenile idiopathic arthritis oligojia, the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Jul 28, 2019 monoarthritis may be a result of infection e.
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