Synovial Lactate and the Diagnosis of Septic Arthritis A monoarticular arthritis is only infrequently an isolated entity unassociated with any other . DIFFERENTIAL DIAGNOSIS OF MONOARTICULAR / OLIGOARTICULAR ARTHRITIS More Common Gout Pseudogout Psoriatic Arthritis Lyme Arthritis Osteoarthritis Rheumatoid Arthritis Uncommon Reactive Arthritis Sarcoidosis (esp. The diagnosis of monoarticular disease in the geriatric population should be based on the composite of medical history, physical examination, relevant imaging, and laboratory studies, including analysis of synovial fluid, and the etiology can remain obscure even after the extensive evaluation. Acute monoarthritis: What is the cause of my patient's A group of adult patients with acute nontraumatic monoarticular arthritis was . PDF Monoarticular rheumatoid arthritis of the wrist: a rare entity Monoarticular joint pain is a common complaint, however it demands a broad differential diagnosis. The differential diagnosis for acute monoarticular arthritis presenting to the ED is broad and includes infections (bacterial, fungal, mycobacterial, viral), crystalloid arthropathy (gout, pseudogout), rheumatoid arthritis, and trauma. Infection is always a major differential, especially in the patient presenting with acute monoarticular arthritis. Septic arthritis should be differentiate from other causes of monoarticular arthritis such as other infectious arthritis, inflammatory arthritis, non inflammatory arthritis, hemorrhagic arthritis and intra articular derangement that causes acute arthritis. [] This determination is generally more difficult when the pain is in proximal, larger joints. Differential Diagnosis I : Tendonitis. Inflammation of the tendons that typically affects the shoulder (rotator cuff), hip, heel, and hamstring. Monoarticular Arthritis - PubMed 7 See Also; 8 References; Background Clinical Features Differential Diagnosis Monoarticular arthritis. The diagnosis is not always evident on a clinical basis and is often part of a differential diagnosis along with a wide group of osseous or extraarticular disorders. 3.1 Monoarticular arthritis; 3.2 Septic Arthritis; 3.3 Crystal-Induced Monoarthritis; 3.4 Traumatic; 3.5 Ischemic; . The most common differential diagnosis for acute inflammatory monoarticular arthritis is crystalline arthritis. The differential diagnosis of acute monoarticular arthritis is broad and includes septic arthritis, crystalline disorders, inflammatory disorders, and mechanical problems with the joint (table 24.1). Management. The differential diagnosis below is organized by these 3 pivotal points as well. Problem Representation - Exercises in Clinical Reasoning differential diagnosis Septic arthritis Crystal arthritis (gout, pseudogout) Haemarthrosis Reactive arthritis Monoarticular presentation of inflammatory arthritis Traumatic synovitis Differential Diagnoses. Septic arthritis is a critical diagnosis that should be considered in all patients with mono- or oligoarticular arthritis; Be aware that immunocompromised patients often present atypically with septic arthritis. Gout is usually monoarticular, and tophi generally occur in the olecranon bursa; in contrast, rheumatoid arthritis (RA) is typically polyarticular and rheumatoid nodules occur more commonly on the extensor . Radiography is often used initially to aid the clinician in the detection and diagnosis of monoarticular arthropathies. Septic arthritis and acute crystalline arthritis can present acutely with rapid progression of symptoms in a matter of hours. Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Acute monoarthritis can have many causes , but crystals, trauma, and infection are most common. The differential diagnosis for monoarticular inflammatory arthritis is narrow, principally gout/psuedogout versus infectious arthritis; It is also possible for both gout and joint infection to co-exist! In children, consider congenital dysplasia of the hip, slipped capital femoral epiphysis, transient synovitis of the . 3. These methods Genitourinary Infection) Oligoarticular (1-4 joints) Gout Psoriatic (Nail Changes, Plaques) Enteropathic (e.g. Because of the high morbidity and mortality, the infection is best managed by an interprofessional team. It also translates the patient's data into medical terms. The number of joints and the time course during which a joint disorder develops guide the approach to differential diagnosis. This patient had no history of podagra, and while gout often causes extreme pain The presentation can be identical to that of a NGA septic arthritis. Arthritis and enteritis- inflammatory bowel disease, Whipple's disease . arthritis but can be very useful in patients presenting with non-characteristic subacute to chronic, monoarticular pain 2. Rheumatoid arthritis. 2-5 The first study described a cohort of 129 patients with acute arthritis who were referred by local general practitioners. Gout and pseudogout commonly affect the knee, ankles and small joints of foot. (See "Evaluation of the adult with polyarticular pain" .) SLE. The differential diagnosis of an acute monoarticular arthritis is shown in Box 1. Differential diagnosis of common causes of chronic polyarthritis. DIFFERENTIAL DIAGNOSIS. Although radiologists have relied on conventional radiography and bone scintigraphy, additional imaging methods have been introduced, such as MR imaging, CT scanning, and US. 2. . A group of adult patients with acute nontraumatic monoarticular arthritis was studied. Monoarticular RA is an infrequent clinical presentation and it usually occurs in the hips and knees. Definition: Acute Monoarthritis Acute single joint inflammation developing in <2 weeks III. relevant investigations.Complete blood count (CBC) with . Pitfalls Septic Joint Septic Arthritis is a rheumatologic emergency (infection may destroy a joint in 48 hours) Arthrocentesis is the only absolutely reliable method to exclude Septic Joint Methods Three pediatric PVNS cases who were misdiagnosed as monoarticular JIA and familial Mediterranean fever (FMF) are presented as case series. Septic Arthritis is a rheumatologic emergency (infection may destroy a joint in 48 hours); Arthrocentesis is the only absolutely reliable method to exclude Septic Joint. No blood test (including elevated Uric Acid level or normal WBC Count, CRP) excludes Septic Arthritis; Do not start antibiotics prior to Arthrocentesis, and do initiate antibiotics afterward if findings suggest Gout can cause episodic joint pains, but most cases are monoarticular. The differential diagnosis below is organized by these 3 pivotal points as well. Synovial Fluid analysis is the KEY to diagnosis. Pitfalls. Women present 70% of the time with polyarticular disease rather than the classic monoarticular arthritis seen in men. Acute osteoarthritis; Avascular necrosis; Crystal-induced . In this regard, the patient had a positive family history for psoriasis, albeit not affecting a first-degree relative. Gram Stains identify an organism in 50% of septic arthritis and Culture increases this to 67%. Disorder Diagnosis Treatment Rheumatoid and reactive arthritis Polyarthritis Intra-articular triamcinolone Biomechanical changes Causative treatment Synovial thickening Septic arthritis Hyperacute arthritis Aspiration and antibiotics Swelling, redness, tenderness and gross articular pattern Gout Hyperacute arthritis Aspiration Joint pain can be caused by an injury that affects any of the ligaments, bursae, or tendons that surround the joint. They review how to distinguish clinically between septic arthritis and gout and which aspects of the presentation and work-up are the most reliable in risk stratifying patients. Typical organisms include gram (+)'s like strep and staph. These differentials include fracture, dislocation, septic arthritis, gout, pseudogout and several others. Although MR imaging of atypical septic arthritis can overlap
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