Pdf converter is a online webbased document to pdf converter software. Monoarthritis is defined as arthritis involving one joint at a time. Management of persistent inflammatory large joint monoarthritis. The causes of monoarthritis can be classified based on their relative frequencies reported in the literature, despite some variability related to methodological differences. A 70yearold male patient presented with pain and restriction of movements of his left wrist. Part ofthe aim ofthe series is to engage the readership in continuing medical education cme continuing professional development cpd. In gout, the acute inflammatory arthritis is caused by excess uric acid caused by either overproduction or underexcretion.
Diagnosis of patients presenting with monoarthritis. We report such a case in a 70yearold male with monoarticular rheumatoid arthritis of the left wrist. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focused investigations. Assessment, investigation, and management of acute. The patients were seen over a 12month period in an acute arthritis clinic in glasgow, scotland. Acute monoarthritis is characterised by pain and swelling of a single joint.
This is a basic article for medical students and other nonradiologists. Monoarticular presentation of rheumatoid arthritis is infrequent and it usually occurs in the hip and knee joints. The current episode began about 1 week prior to presentation and. Pdf isolated knee monoarthritis heralding resectable non. Approach to monoarticular arthritis clinical pearls. Septic arthritis must be always be considered and excluded in any monoarthritis. The principal diagnosis to consider is septic arthritis, as a failure rapidly to diagnose this condition can lead to irreversible severe joint damage in a very short time. Oligojia affects one to four joints within the first 6 months of disease. Monoarthritis, defined as inflammation of a single joint, requires a thorough physical examination in children, as pain may be lacking in 10% to 30% of cases and joint stiffness may be the only symptom. Patterned approach grouping a constellation of symptoms, signs and investigations to arrive at a diagnosis. Monoarthritis is relatively unusual so infection and crystalline arthropathies should always be. A detailed history and clinical examination is important to reach a correct diagnosis and. Monoarthritis definition of monoarthritis by medical dictionary.
It may be a large weightbearing joint, or a smaller joint such as an interphalangeal joint, the great toe metatarsalphalangeal joint, or an elbow. Our aim is to offer an outline of how to assess, investigate, and manage a patient with. The first step in diagnosis is to verify that the source of pain is the joint, not the surrounding soft tissues. Understand the most common microbial causes of nonpurulent cellulitis. Approach to acute monoarthritis is the property of its rightful owner. Rea most often affects adults between 18 and 40 years of age and presents as a monoarthritis or oligoarthritis. Almost any joint disorder may begin as monoarthritis, or inflammation of a single joint. One of the most common causes of acute monoarthritis is gout. Objectives understand the definition and epidemiology of uncomplicated, nonpurulent cellulitis.
He is an assistant professor at the university of toronto, division of emergency medicine and the education innovation lead at the schwartzreisman emergency medicine instititute. Microsoft word monoarticular arthritis show notes pdf. Diagnosing acute monoarthritis the diagnosis of acute monoarthritis begins with a comprehensive history and physical examination to reveal potential diagnostic clues3,6,17 table 21,3,6,12,18,19. Polyarticular conditions can present initially with a single inflamed joint. Joel yaphe, university of torontos emergency medicine residency program director and dr.
Ppt approach to monoarthritis powerpoint presentation. Pigmented villonodular synovitis is usually seen in young adults, with a peak presentation between the 3rd and 4th decades of life. Acute monoarthritis can be the initial manifestation of many joint disorders. Rheumatoid arthritis reiters syndromereactive arthritis juvenile rheumatoid arthritis psoriatic arthritis viral arthritis enteropathic arthritis sarcoid arthritis whipples disease the most likely causes of chronic monoarthritis inflammation within a single joint for 6 weeks. Monoarthritis refers to the clinical presentation of pain or swelling in a single joint. Atypical monoarthritis presentation in children with. The pattern, presentation and duration of arthritis help differentiate between the various possible diagnoses. He is the founder, editorinchief and host of emergency medicine cases. Jul 28, 2019 monoarthritis may be a result of infection e. Acute monoarthritis is joint inflammation arthritis of one joint. Bursitis and tendinitis can present in a similar manner so it is important to establish that the problem is within the joint. Jan 11, 2017 acute monoarthritis is joint inflammation arthritis of one joint. It causes the inflammation of the joints and often starts in the feet or toes.
What is your general approach to a patient with acute monoarthritis. Gout can cause mono or polyarthritis, but usually results in monoarthritis first. Anton helman is an emergency physician at north york general in toronto. What should we always assume is the cause until proven otherwise. No studies that evaluated patient history or findings from physical examination met our inclusion criteria. Apr 30, 2017 precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focused investigations.
Assessment,investigation, andmanagementof acutemonoarthritis simonhtill, mlsnaith the theme of this series is the managementof everydayclinicalproblems thatpresent to accident and emergency departments. Reactive arthritis including the initial presentation. Juvenile idiopathic arthritisadultonset stills disease. A free powerpoint ppt presentation displayed as a flash slide show on id. Diagnosing acute monoarthritis in adults free download as pdf file. Transient synovitis of the hip is fairly characteristic but rarely investigated by joint aspiration. The knee, ankle, or one of the metatarsophalangeal joints is usually affected first.
Common causes of monoarthritis are infection, trauma and crystalinduced synovitis. Jul 19, 2019 arthritis is the swelling and tenderness of one or more of your joints. Almost half of jia patients are diagnosed with oligoarticular juvenile idiopathic arthritis oligojia. Common septic arthritis osteoarthritis posttraumatic gout charcot joint neuropathic joint pigmented villonodular synovitis pvns synovial osteochondromatos. Night pain, morning stiffness, systemic symptoms, recent nonarticular infections. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. Monoarthritidies have a relatively short differential diagnosis, including. Because knee monoarthritis is the most common presentation of. 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.
The most common types of arthritis are osteoarthritis and rheumatoid arthritis. Monoarthritis is a common clinical presentation in general medical and rheumatology practices. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. To describe isolated knee monoarthritis as a paraneoplastic syndrome heralding nonsmall cell lung cancer nsclc, and to discuss its clinical characteristics. Nov 21, 2016 gonococcal arthritis is the most common type of nontraumatic monoarthritis in young, sexuallyactive young adults. If so, share your ppt presentation slides online with. Monoarthritis must be regarded as potentially septic until proven otherwise. Review the 2014 idsa guidelines for management of mild, nonpurulent. Convert and create pdf from various types of files like word doc, excel xls, powerpoint ppt. However, according to articles published by experts in the field, the initial approach to diagnosing acute monoarthritis should involve the completion of both a history and a physical examination. Where there is any question of this diagnosis, immediate inpatient assessment and management are the safest course 1, 2. If you wanna take it down, feel free to let me know. Investigation of acute monoarthritis summary radiology. Monoarthritis definition of monoarthritis by medical.
Indy ghosh discuss the difficult diagnostic dilemmas when faced with a patient with acute monoarthritis. Synovial fluid examination is the most important investigation. We identified 4 studies that reported on the differential diagnosis of acute arthritis. Monoarthritis in a young adult should raise the possibility of rea. Acute monoarthritis with associate professor neil mcgill, consultant rheumatologist at royal prince alfred hospital 1. 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. Oct 30, 2012 persistent inflammatory monoarthritis is inflammation of one joint, with symptoms lasting beyond 3 months. Assessment, investigation, and management of acute monoarthritis. Monoarthritis differential radiology reference article. Ppt gout powerpoint presentation free to download id.
Before the age of menopause, women have a lower incidence than males, but the rates are equal above this age. Gonococcal arthritis is the most common type of nontraumatic monoarthritis in young, sexuallyactive young adults. Approach to a child with monoarthritis springerlink. Persistent inflammatory monoarthritis is inflammation of one joint, with symptoms lasting beyond 3 months. Diagnosing acute monoarthritis in adults gout arthritis. There are a number of causes, with crystals, trauma and infection being the most common.
In 2006, the european league against rheumatism developed evidencebased recommendations for the diagnosis of gout. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. There are several possible causes of monoarthritis or monoarticular arthritis as it is also called, including infection, nonspecific inflammatory conditions, crystal deposition, trauma, neoplasm, and immunologic conditions. The first step in diagno sis is to verify that the source of pain is the joint, not the surrounding soft tissues. Scribd is the worlds largest social reading and publishing site. Joint infection or trauma to a joint causes acute monoarthritis.
Gout can cause mono or polyarthritis, but usually results in. Ppt approach to acute monoarthritis powerpoint presentation. Pdf approach to a child with monoarthritis researchgate. Read the medical definition of monoarthritis, arthritis that occurs in only one joint at a time. Rheumatoid arthritis with monoarthritic presentation. James talks to associate professor neil mcgill about the management of acute monoarthritis on the wards. Patients presenting with a single painful andor inflamed joint require thorough and rapid assessment. The common presentation is monoarthritis of the knee in girls younger than 6 yearold, often in association with positive antinuclear antibodies ana. Acute monoarthritis is a rheumatologic emergency acute monoarthritis should always be assumed to be caused by an infection. Acute monoarthritis inflammatory process involving a single joint develops over a few days any rheumatic disease can present as monoarthritis monoarthritis is not the initial symptom of a systemic connective tissue disease. When dealing with a single joint location, need to check to make sure it is actually arthritis, as you need to consider the following.
827 1431 800 1187 1020 1499 712 258 243 33 1084 1211 734 784 1588 928 419 659 589 739 1643 232 270 449 284 801 472 96 502 1108 500 861 710 737 252 1294 281