The authors report two patients with chronic monoarthritis due to. Patients were treated according to the initial work up and diagnosis made. Treatment of refractory inflammatory monoarthritis in ankylosing spondylitis by intraarticular injection of infliximab. When faced with monoarthritis, one of the main decisions to make is whether to perform a joint aspirate by inserting a needle into the affected joint and removing some fluid for microscopic analysis. A delay in diagnosis and treatment, particularly in septic arthritis, can have catastrophic results. Rather, diagnosis depends on the findings of the clinical examination and supporting investigations and on patient response to treatment. The advent of biologic agents has had a major impact on the treatment of psa. The presence of monosodium urate crystals in the synovial. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. We observed a beneficial effect of ia infliximab in refractory arthritis in patients with as. Background pigmented villonodular synovitis pvns is a proliferative disorder of synovium that affects synovial joints, tendon sheaths and bursas.
This procedure could be considered an effective and safe treatment for therapy of refractory monoarthritis in as and an alternative for parenteral tnfblocking therapy. Arriving at a correct diagnosis is crucial for appropriate treatment. Acute monoarthritis should be considered infectious until proven otherwise. Jan 01, 2006 treatment of refractory inflammatory monoarthritis in ankylosing spondylitis by intraarticular injection of infliximab. Pdf approach to a child with monoarthritis researchgate. If initial work up did not reveal diagnosis, symptomatic treatment was offered.
Classification of arthritis by numberof joints involved 1. No clear gold standards exist for diagnosing the cause of acute monoarthritis. Intraarticular infliximab in dmardresistant knee monoarthritis. Common causes of monoarthritis are infection, trauma and crystalinduced synovitis. Reactive arthritis including the initial presentation.
Night pain, morning stiffness, systemic symptoms, recent nonarticular infections. A cute monoarthritis is a common clinical presentation in emergency departments and in general medical and rheumatology practices. A general approach to joint pain focusing on acute monoarthritis. Bursitis and tendinitis can present in a similar manner so it is important to establish that the problem is within the joint. The diagnostician must utilize a patients medical history, physical examination, xrays, blood tests. 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. Joint pain more severe than that found in ra is characteristic of pseudogout or gout, which may resemble or even complicate ra. The objective of the treatment for monoarthritis is to give relief to the pain, prevent further attacks, and reduce the inflammation. Tedeschi on a general approach to joint pain focusing on acute monoarthritis, part of a collection of online lectures.
Otherwise she is well with no systemic upset and no fever. Assessment, investigation, and management of monoarthritis. Acute monoarthritis of the knee, shoulder, or hip can present a picture suggesting a septic, pseudogout, or gouty process, although this finding is rare. Monoarticular rheumatoid arthritis is a form of rheumatoid arthritis, which is an often painful inflammatory disorder of the joints, that strikes only a single joint in a particular individual. On physical examination, she appeared cachexic, her left knee was swollen and tender. Pdf on jun 1, 2017, ingo schmidt and others published kienb ck s disease mimicing gouty monoarthritis of the wrist find, read and cite all the research you need on researchgate.
An approach to patients with a chronic monoarthritis. Keratoderma blennorrhagicum an overview sciencedirect. The joint becomes painful, warm and tender and the condition is indistinguishable from other forms of arthritis. Diagnosis of patients presenting with monoarthritis uzma rasheed et al. Septic arthritis demands early diagnosis and correct treatment if the function of the joint is to be restored. Jul 01, 2003 acute monoarthritis can be the initial manifestation of many joint disorders. It is therefore imperative that joint infection is considered above all other diagnoses.
Reactive arthritis is a rare complication of genital chlamydia. Although plain radiographs are not always necessary in the investigation of acute monoarthritis they can be helpful to establish the diagnosis of monoarthritis and provide a baseline for followup. Pitfalls in the diagnosis and early treatment of acute monoarthritis include failure to perform arthrocentesis, administering. Osteoarthritis was long believed to be caused by the wearing down of joints over time. Msu is a very potent activator of the innate immune system il1 is released recruits inflammatory cells. Acute pain and swelling in a joint always require immediate evaluation. This decision is largely taken on inflammatory markers in blood tests e. The first step in diagnosis is to verify that the source of pain is the joint, not the surrounding soft tissues. Previous areas of bone loss remained quiescent without bone infilling. What you need to know about monoarticular rheumatoid arthritis. Study 30 38 acute monoarthritis and gout flashcards from julian r. A delay in diagnosis and treatment, particularly in septic arthritis, can have catastrophic results including sepsis, bacteremia, joint destruction, or death.
Acute causes include infection, trauma, crystalinduced arthritis. Acute monoarthritis dt deposits of monosodium urate msu crystals in joints and tendons. Drugs are also associated with acute arthritis either through their metabolic consequences or as idiosyncratic drug reactions. The differential diagnosis of an acute monoarthritis can also overlap with that of polyarthritis since virtually any polyarthritis disorder can initially present as a monoarthritis. Sometimes, as in fungal infection, signs and symptoms may be mild and the diagnosis delayed. 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. Sporothrix schenckii infection presented as monoarthritis. Treatment of refractory inflammatory monoarthritis in.
Radiographs and ct revealed severe stifle monoarthropathy and distal femoral osteolysis without periosteal proliferation, mild. Assessment, investigation, and management of acute. Polyarticular conditions can present initially with a single inflamed joint. No other clinical abnormalities were found except for two subcutaneous tarsal nodules. A 19yearold girl presented to the rheumatology clinic for left knee monoarthritis for the past 4 months. Pitfalls in the diagnosis and early treatment of acute monoarthritis include failure to perform arthro centesis, administering antibiotics before aspirating the joint when septic arthritis is. Because patients with acute monoarthritis often present to their family physician, a proper diagnostic approach is important figure 1. Assessment, investigation, and management of acute monoarthritis. The presentation of such symptoms requires rapid diagnosis and treatment to prevent joint destruction. Leishmaniosis manifesting as osteomyelitis and monoarthritis. May 24, 2019 monoarthritis can be defined as arthritis that involves one joint at one time.
On the basis of the differential diagnosis of acute monoarthritis, the patients physician assumes that the pretest probability for gout is about 20% pretest odds 0. Mri of the left knee showed a soft tissue swelling extending into the knee joint. Joint pain is among the most common complaints encountered in family practice. Pdf kienb ck s disease mimicing gouty monoarthritis of the. Jan 06, 2009 on the basis of the differential diagnosis of acute monoarthritis table 1, the patients physician assumes that the pretest probability for gout is about 20% pretest odds 0. Geisler, in infectious diseases fourth edition, 2017. Pvns is usually found in adults aged 2050 years, but it may occur also in children. Key points a number of conditions may present as acute monoarthritis. Delayed diagnosis of ewings sarcoma in a young patient.
Know the causes, symptoms, diagnosis and treatment of monoarthritis. The most common diagnoses in the primary care setting are osteoarthritis, gout, and trauma. Septic arthritis causes, symptoms, diagnosis, treatment. Acute monoarthritis can be the initial manifestation of many joint disorders. There are a number of causes, with crystals, trauma and infection being the most common. Nov 21, 2016 gonococcal arthritis is the most common type of nontraumatic monoarthritis in young, sexuallyactive young adults. Synovial fluid examination is the most important investigation. The american college of radiology has established guidelines for the assessment of a limping child. The antitnf agents have been studied most extensively, indicating the efficacy of infliximab, etanercept, adalimumab, and golimumab. A nineyearold male, neutered, mixedbreed dog was presented with chronic left pelvic limb lameness, moderate muscular atrophy and pain on palpation of the lateral femoral condyle. Treatment patients typically receive aggressive treatment for psoriasis chapter 446.
In septic arthritis theres joint inflammation, which can be caused by various bacterial infections which spread contiguously or hematogenously. A multidisciplinary approach to the management of these patients is strongly encouraged as some will have unusual diseases that require specialist advice. Arthrocentesis is an essential emergency medicine skill that is often diagnostic as well as therapeutic relieves pain and is part of the treatment in septic arthritis, and has a very low complication rate. Diagnosis of patients presenting with monoarthritis. There are numerous possible causes of monoarticular arthritis or monoarthritis that includes trauma, infection, nonspecific inflammatory conditions, neoplasm, crystal deposition, and immunologic conditions. Use of the clinical examination, with or without additional tests, to make a definitive diagnosis is not unique to arthritis.
Ppt approach to acute monoarthritis powerpoint presentation. Pdf kienb ck s disease mimicing gouty monoarthritis of. Although there are many other lessthreatening causes of monoarthritis, inadequately treated infectious arthritis carries a r. Acute monoarthritis in a delayed diagnosis of syphilis. Keratoderma blennorrhagicum an overview sciencedirect topics. The diagnostician must utilize a patients medical history, physical examination, xrays, blood tests, and synovial fluid exam to determine the. Acute monoarthritis is characterised by pain and swelling of a single joint. Treatment with miltefosine and allopurinol was successful in achieving clinical remission. The history and physical examination can help guide continue reading. Our aim is to offer an outline of how to assess, investigate, and manage a patient with monoarthritis. But scientists now see it as a disease of the joint. Many joint disorders initially can produce pain and swelling in a. Despite advances in antibiotic treatment diagnostic delay partlyexplainswhyseptic arthritis is still associated with considerable morbidity and mortality.
Approach to acute monoarthritis 1 approach to acute monoarthritis. She also had constitutional symptoms with significant weight loss. A nonspecific reactive monoarthritis may be a feature of a wide variety of common and uncommon infections including, brucellosis, lyme disease, and leptospirosis. Read on to learn more about this specific form of rheumatoid arthritis, including its common causes, symptoms, how it is diagnosed, and its recommended treatments. It is important to understand the prevalence of specific etiologies and to use the appropriate diagnostic modalities. As it is a rare pathology in children, diagnosis is often. It is not difficult to appreciate how the patient with monoarthritis can present the clinician with a fascinating diagnostic and therapeutic challenge. It is therefore imperative thatjointinfectionis consideredaboveall otherdiagnoses. A number of conditions may present as acute monoarthritis, and treatment will ultimately depend on the underlying diagnosis.
Pdf assessment, investigation, and management of acute. James talks to associate professor neil mcgill about the management of acute monoarthritis on the wards. In contrast to children with septic arthritis sa, children with transient synovitis appear well and are usually afebrile with just a mild limp. The risk of developing oa increases someone gets older because bones, muscles and joints are also aging. A general approach to joint pain focusing on acute. Gonococcal arthritis is the most common type of nontraumatic monoarthritis in young, sexuallyactive young adults.
It often affects the knee and is characterized by systemic symptoms of sepsis e. She is unable to sit crosslegged on the floor at school. The differential diagnosis of a painful monoarthritis is rather extensive. The onset of monoarthritis is often sudden and intense with fever, joint pain, and joint swelling. Monoarthritis is inflammation of one joint characterized by joint swelling, pain. Our aim is to offer an outline of how to assess, investigate, and manage a patient with. Swollen knee monoarthritis a 5 year old girl presents with 6 weeks of leg pain and noted to be stiff in the mornings.
Acute monoarthritis is a common clinical presentation in emergency departments and in general medical and rheumatology practices. The maximum dosages of the oral antiinflammatory drugs are used along with antacids for monoarthritis. Leishmaniosis manifesting as osteomyelitis and monoarthritis in a dog and outcome following treatment with miltefosine and allopurinol veterinary record case reports. It is characterized by an aseptic rheumatoid factornegative asymmetric polyarthritis that may be accompanied by conjunctivitis, a rash of the extremities keratoderma blennorrhagica, andor painless oral ulcers. Diagnostic rule for gout when synovial fluid analysis is unavailable acute monoarthritis. Tedeschi on a general approach to joint pain focusing on acute monoarthritis, part of a. Bmc infectious diseases acute monoarthritis in a delayed diagnosis of syphilis patient with persistent rupioid psoriasis like lesions kejian zhu 0 qiang zhou 0 rui han 0 hao cheng 0 0 department of dermatology, sir run run shaw hospital, zhejiang university school of medicine, no. Years of recurrent gout with hyperuricemia and inadequate treatment. A delay in diagnosis and treatment, particularly with septic arthritis, can. Despite advances in antibiotic treatment diagnostic delay partly explains why septic arthritis is still associated with considerable morbidity and mortality. Nevertheless, the outcome of fungal arthritis is severe and usually causes joint disability. Acute monoarthritis acute inflammatory process that develops in a single joint over the course of a few days and less than two weeks.