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monoarticular arthritis

Arthritis involving a single joint. Etiology: 1) osteoarthritis (also oligoarticular) 2) infectious arthritis (also oligoarticular) - acute: see infectious arthritis - chronic: mycobacterial, fungal, Lyme disease (see infectious arthritis) 3) crystalline arthritis a) gout b) CPPD (also oligoarticular) c) hydroxyapatite deposition disease 4) trauma 5) osteonecrosis (avascular osteonecrosis) 6) tumor 7) hemarthrosis [2] 8) early connective tissue disease Clinical manifestations: - see arthritis Laboratory: - if acute, joint aspiration with synovial fluid analysis - gram stain, culture, crystal analysis - rule out/in infectious arthritis, crystalline arthritis [1] - gram stain negative in 20% of septic arthritis, especially common with gram-negative organisms - also see arthritis Radiology: - see arthritis Differential diagnosis: - chronic inflammatory monoarticular arthritis suggests infectious arthritis a) tuberculous arthritis b) fungal arthritis c) Lyme arthritis Management: - empiric antibiotic therapy while awaiting culture results - ceftriaxone & vancomycin - see arthritis Prognosis - most cases resolve within 2 years - 1/4 of cases evolve into rheumatoid arthritis, psoriatic arthritis or other inflammatory arthritis [5]

General

arthritis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16,17 American College of Physicians, Philadelphia 2012,2015
  2. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  3. Baker DG, Schumacher HR, Jr. Acute Monoarthritis. N Engl J Med 1993; 329:1013-1020. September 30, 1993 PMID: 8366902 http://www.nejm.org/doi/full/10.1056/NEJM199309303291407
  4. Becker JA, Daily JP, Pohlgeers KM. Acute Monoarthritis: Diagnosis in Adults. Am Fam Physician. 2016 Nov 15;94(10):810-816. PMID: 27929277 Free Article
  5. Norli ES, Brinkmann GH, Kvien TK et al. Joint distribution and two-year outcome in 347 patients with monoarthritis of less than sixteen weeks' duration. Arthritis Care Res (Hoboken) 2020 May; 72:705. PMID: 28777897 https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23334