Makindo Medical Notes"One small step for man, one large step for makindo" |
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Related Subjects: |Monoarticular arthritis |Polyarticular arthritis |Rheumatoid arthritis |Gout |Pseudogout |Septic Arthritis |Systemic Lupus Erythematosus (SLE) |Enteropathic Spondyloarthritis |Reactive Arthritis
Acute monoarthritis requires urgent investigation and treatment. The key investigation is synovial fluid aspiration with Gram stain and culture and analysis for crystals in gout and pseudogout. Always check with orthopaedics before aspirating a prosthetic joint
Causes | Comments |
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Osteoarthritis | A single joint may be affected. Painful but rarely any acute inflammatory issues |
Acute Gout | Comes on over hours. Severe pain. Usually 1st MTP. Red hot. Aspirate joint if diagnosis uncertain need to exclude sepsis. Examine for crystals. Recent dehydration, operation |
Acute Pseudogout | Comes on over hours. Severe pain. Wrist and shoulder. Red hot. Aspirate joint if diagnosis uncertain need to exclude sepsis. Examine for crystals |
Septic joint | Acute pain on over 1-2 days. Severe. Red hot. Aspirate. |
Disseminated gonococcal infection | Young adults. Single or multiple joint acute pain on over 1-2 days. Severe. Red hot. Aspirate. |
Reactive arthritis | Recent GI or STD infection. Acute pain. Aspirate if effusion but usually sterile. |
Trauma/Haemarthrosis | Recent injury. Swelling due to bleeding into the joint. Exclude a fracture with plain X rays. Aspirate. |
Rheumatoid arthritis | Can occasionally flare in just one joint. Usually a synovitis and tender to squeeze. Not red hot like crystals or sepsis. |
Seronegative sponyloarthropathies | Psoriasis, Inflammatory bowel disease, Ankylosing spondylitis HLAB27 |
Prosthetic joint | Always get an orthopaedic review before attempted aspiration |
Erythema nodosum | Skin rash over lower legs, TB, Sarcoid, recent strep infection CXR ?? BHL |