Acute monoarthritis

Posted by e-Medical PPT Thursday, July 12, 2012
Acute monoarthritis is a potential medical emergency that must be investigated and treated promptly. Common diagnoses include Septic arthritis,Gout,mechanical complications of osteoarthritis and Traumatic arthritis; less common causes are ischemic necrosis (osteonecrosis),hemarthrosis or tumour. However, first and foremost, acute monoarthritis should be considered septic until proven otherwise.
An accurate diagnosis of acute monoarthritis depends on a good history and physical examination that are supplemented by the appropriate investigations. The factors determining whether the arthritis is inflammatory or mechanical in nature and whether the disease is acute or chronic will then help to arrive at a presumptive diagnosis.
Investigations should include joint aspiration of synovial fluid for a leukocyte count, Gram’s stain, cultures and an examination for crystals; radiographs of the joint may also be required. Occasionally, a radionuclide scan, CT or MRI is useful.
Treatment is based on the underlying diagnosis, but antibiotics may be required until septic arthritis is excluded.
If acute monoarthritis is apparent from the history and physical examination themost common differential diagnoses are infectious arthritis, crystal-induced arthritis and trauma-induced arthritis3; these can be differentiated by history,
physical examination and synovial fluid analysis.
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