Arthritis, Monoarticular
Basics
Description
Description
- Localized to 1 joint, not migratory
- Infectious (septic) arthritis: Rapidly destructive process causes significant disability
- Contiguous extension (cellulitis, osteomyelitis), hematogenous spread, direct inoculation
- Predisposing factors:
- Local pathology (inflammatory arthritis, trauma, prosthetic joint)
- Immunosuppression
- IV drug use
- Crystal arthropathy:
- Gout: Uric acid overproduction or underexcretion, deposited within and around joints
- Pseudogout: Calcium pyrophosphate
- Various arthropathies:
- Osteoarthritis or degenerative joint disease (DJD), trauma (fractures, hemarthrosis), autoimmune disorders
- Progressive joint destruction; mechanical dysfunction
- Bone reactive changes (spurring)
- Subchondral bony erosions
- The presence of one etiology does not exclude another
Etiology
Etiology
- Infectious (septic)
- Most common organisms nongonococcal
- Gram-positives: Streptococcus, Staphylococcus (80%)
- Some associations:
- Staphylococcus aureus: Trauma, IV drug use
- Neisseria gonorrhoeae (STI)
- Salmonella (sickle cell) but most common causes in sickle cell Staphylococcus, Streptococcus
- Less common: Fungal (chronic), spirochete (Lyme), viral (polyarticular), mycobacteria (TB)
- Most common organisms nongonococcal
- Crystal arthropathy:
- Gout: Uric acid overproduction, underexcretion within or around joints
- Tophi: Crystal deposits near recurrent flare sites. Progressive enlargement, may ulcerate through skin
- Negatively birefringent crystals
- Pseudogout: Calcium pyrophosphate
- Positively birefringent crystal
- Bariatric surgery: Postoperative gout flares are a common occurrence
- Inflammatory:
- Rheumatoid, Psoriatic, inflammatory bowel disease, Reiter syndrome
- Other conditions:
- Osteoarthritis DJD, overuse, overload (obesity)
- Trauma
- Hemorrhagic disorders
- Neuropathic disorders (Charcot joint)
Pediatric Considerations
- Infectious (septic) arthritis:
- Low incidence, high morbidity, sepsis (8%)
- Most common: S. aureus, hip > knee, 50% coexisting osteomyelitis
- Present like adults: Joint swollen, painful, worsened with weight bearing, movement; constitutionally ill, limp
- Aspiration, empiric treatment, admission
- Inflammatory:
- A diagnosis only after septic joint excluded
- Other considerations same as adults + juvenile idiopathic arthritis
- Other considerations to not overlook:
- Salter–Harris epiphyseal plate fractures
- Congenital hip dysplasia
- Slipped capital femoral epiphysis (SCFE)
- Overweight adolescents
- Legg–Calve–Perthes:
- Avascular necrosis femoral head
- Age 4–9
- Bleeding disorders, hemorrhage
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Citation
Schaider, Jeffrey J., et al., editors. "Arthritis, Monoarticular." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307174/all/Arthritis__Monoarticular.
Arthritis, Monoarticular. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307174/all/Arthritis__Monoarticular. Accessed January 10, 2025.
Arthritis, Monoarticular. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307174/all/Arthritis__Monoarticular
Arthritis, Monoarticular [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2025 January 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307174/all/Arthritis__Monoarticular.
* Article titles in AMA citation format should be in sentence-case
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T1 - Arthritis, Monoarticular
ID - 307174
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ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307174/all/Arthritis__Monoarticular
PB - Lippincott Williams & Wilkins
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DB - Emergency Central
DP - Unbound Medicine
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