Acute Monoarthritis
Introduction:
Acute monoarthritis = a single joint that has been inflamed for less than 6 weeks
Causes:
1. Septic arthritis
2. Acute gout
3. Acute pseudogout
What should you do to investigate?
o Aspirate the joint (take a small sample of fluid from the joint) → if the joint is red, aspirate it!
o Send the fluid for the 3 Cs:
i. Cell count → takes a couple of hours
ii. Culture → take 24-48 hours
iii. Crystals → takes a couple of hours
i. Also send for a gram stain
1) Septic Arthritis:
Patient Case:
Mr. Williams is a 62 year old man presents with a left ankle that has recently become much more painful, warm, and red
He has diabetes (and is on metformin and glyburide) and has had his right knee replaced due to osteoarthritis
He recently had a pedicure for diabetes
Physical exam:
o Temperate = 38.6oC
o He is flushed and in pain
o Left ankle is warm, red, and extremely painful
o Cannot put much weight on the ankle
He is sent urgently to the emergency department with a diagnosis of “suspected left ankle infection”
Orthopedic surgery is consulted and they aspirate the joint:
i. Cell count = 59 x 109 cells/L (inflammatory!)
ii. Crystals = negative
iii. Gram Stain = gram positive cocci in clusters
iv. Culture = pending
Acute Bacterial Arthritis = A Medical Emergency!
Without rapid detection and appropriate treatment, it can quickly lead to fulminant joint damage
This can happen in just days
Risk Factors:
Systemic Risk Factors: Local Risk Factors:
Immunosuppressed Individuals: Presence of a prosthetic joint
o Diabetics Recent joint surgery
o Cancer Underlying joint abnormality (ex. arthritis)
o Certain medications (ex. methotrexate, leflunomide, Direct penetrating trauma
prednisone, Anti-TNF alpha drugs, other biologics) Skin infection
Age → very young or old
Lifestyle → alcohol excess, IV drugs
Recent infection
Definition of Osteoarthritis:
Osteoarthritis is the most common form of chronic monoarthritis
It is a joint disease characterized clinically by:
o Pain that typically worsens with weight bearing and activity and improves with rest
o Morning stiffness and gelling of the involved joint after periods of inactivity
o Tenderness on palpation, bony enlargement, crepitus on motion, and/or limitation of joint motion
Epidemiology:
o Affects 1 in 10 Canadians
o OA is associated with significant costs:
Direct = drugs, healthcare resource use
Indirect = lost employment time, costs of informal caregiving
Under treatment leads to significant pain and loss of quality of life ☹
Clinical characteristics:
o Insidious over months to years
o Associated with morning stiffness for 15-30 minutes
o Usually occurs in those of older age, and in women more than men
o Causes pain with activity
o Boney enlargements
o Distribution of joints:
i. Hands = DIP, PIP, 1st CMC joints
ii. Hip
iii. Knee
iv. Feet = first MTP
v. Spine = cervical, lumbar
Osteoarthritis Vs. Rheumatoid Arthritis: