Rheumatology Book

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Monoarticular ArthritisAka: Monoarthritis, Monoarticular Joint Pain, Acute Monoarthritis

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  1. Definition: Acute Monoarthritis
    1. Acute single joint inflammation developing in <2 weeks
  2. Pitfalls: Septic Joint
    1. Septic Arthritis is a rheumatologic emergency
    2. Infection may destroy a joint in 48 hours
  3. Causes: Monoarticular (Mnemonic: SINGL JOINT)
    1. Septic Arthritis (most important to rule-out)
      1. Bacterial arthritis
      2. Fungal arthritis
      3. Parasitic arthritis
    2. Internal derangement or trauma
      1. Meniscus Injury
      2. Ligament tears
    3. Reactive Arthritis (aseptic infammatory arthritis)
    4. Neuropathy (Charcot's Joint)
    5. Gout, Pseudogout and other crystal-induced arthritis
    6. Lyme Disease
    7. Juvenile or adult Rheumatoid Arthritis
    8. Osteitis Deformans (Paget's Disease)
    9. Osteoarthritis
    10. Osteomyelitis
    11. Ischemic bone (avascular necrosis)
    12. Acute Retroviral Syndrome (initial HIV Presentation)
    13. Neoplasms
      1. Osteoid Osteoma
      2. Villonodular synovitis
    14. Trauma
      1. Overuse injury
      2. Fractures
      3. Hemarthrosis
  4. History
    1. Predisposing factors
      1. Pre-existing Osteoarthritis
        1. Higher infection risk
      2. Prolonged Corticosteroid use
        1. Septic Arthritis
        2. Avascular necrosis
    2. Timing of pain and swelling
      1. Extremely rapid onset within minutes
        1. Traumatic arthritis (e.g. Fracture)
      2. Onset over hours to days
        1. Septic Arthritis
        2. Crystal arthritis (e.g. gout)
      3. Onset over weeks to months
        1. Systemic Rheumatic disease
        2. Indolent infection
        3. Osteoarthritis
        4. Tumor
      4. Chronic or Long-standing
        1. Aggravated Osteoarthritis
        2. Crystal arthritis
    3. Location
      1. Migratory
        1. Gonococcal Arthritis (Gonorrhea)
        2. Rheumatic Fever
      2. Consider multiple joint involvement
        1. Oligoarthritis (<=4 joints)
        2. Polyarthritis
  5. History: Extraarticular Symptoms
    1. Reiter's Syndrome
      1. Urethritis
      2. Conjunctivitis
      3. Diarrhea
      4. Rash
    2. Psoriatic Arthritis
      1. Psoriasis
      2. Nail Pitting
    3. Gout
      1. Diuretic use
      2. Tophi
      3. Renal stones
    4. Ankylosing Spondylitis
      1. Uveitis
      2. Low Back Pain
    5. Sarcoidosis
      1. Hilar Adenopathy
      2. Erythema Nodosum
    6. Gonococcal Arthritis
      1. Young adults with high risk sex history
      2. Migratory polyarthralgias
      3. Tenosynovitis of hands and feet
      4. Pustules
    7. Coagulopathy
      1. Bleeding tendency
      2. Anticoagulant use
    8. Avascular Necrosis
      1. Systemic Lupus Erythematosus
      2. Corticosteroid use
      3. Alcohol Abuse
    9. Septic Arthritis
      1. Immunosuppression
      2. Intravenous Drug Abuse
      3. Abnormal joint
      4. Remote infectious source
  6. Symptoms
    1. Joint pain and swelling
    2. Erythema over joint
      1. Infection
      2. Crystal arthritis
    3. Skin Desquamation over joint
      1. Gout
  7. Signs
    1. Distinguish articular from periarticular arthritis
      1. Bursitis
      2. Fracture
      3. Tendonitis
    2. Range of motion
      1. Active range of motion limitation
        1. Suggests periarticular problems
      2. Passive range of motion limitation
        1. Suggests articular problems
    3. Palpation
      1. Swelling and pain
    4. Joint effusion
      1. Most specific sign of joint inflammation
    5. Stress Pain (pain at extreme range of motion)
      1. Most sensitive sign of joint inflammation
    6. Examine all joints
      1. Assess for Polyarthritis
    7. Extra-articular exam
  8. Labs
    1. Synovial Fluid Exam
    2. Erythrocyte Sedimentation Rate (ESR)
    3. Antinuclear Antibody (ANA)
    4. Rheumatoid Factor (RF)
    5. Complete Blood Count (CBC)
  9. Radiology
    1. XRay of affected joint
      1. Initial XRay in acute monoarthritis most often normal
    2. CT or MRI of affected joint
      1. Not a first line study
      2. Use only for specific indications

Unspecified monoarthritis of unspecified site (C0158026)

ConceptsDisease or Syndrome (T047)
ICD9716.6, 716.60
EnglishARTHRITIS SINGLE JOINT, MONARTHRITIS, Monoarthritis, Unspecified monoarthritis, Unspecified monoarthritis of unspecified site
Spanishmonoartritis, monoartritis no especificada
Parent Conceptsother arthropathy (C0679388), Unspecified monoarthritis of unspecified site (C0158026), Other and unspecified arthropathies (C1442831), Arthritis (C0003864), Duplicate concept (C1274013)
SourcesAOD, CST, ICD9CM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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