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Acute Monoarthralgia

Acute Monoarthralgia. Presentation. Marilyn 67 y.o. woman Presents to GP with red painful right big toe which has kept her awake most of last night. She was well when she went to bed. No recent illnesses.

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Acute Monoarthralgia

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  1. Acute Monoarthralgia

  2. Presentation Marilyn 67 y.o. woman Presents to GP with red painful right big toe which has kept her awake most of last night. She was well when she went to bed. No recent illnesses. Issues to consider.1.    How is arthritis described in terms of joint involvement? 2.    What are the causes of acute monoarticular arthritis? 3.    Can they be distinguished on history and examination?

  3. Joint involvement • Number of joints – mono, oligo, poly arthritis • Symmetrical or not • Small or large joints • Peripheral or axial

  4. Joint involvement SLE, Sarcoidosis, leukaemia, endocarditis, haemochromatosis, sickle-cell anaemia, familial Mediterranean fever, Behçet’s.

  5. Acute monoarticular arthritis • Trauma • Bleed • Infection (Danger!) • Gout / pseudogout

  6. Septic arthritis • Uncommon but dangerous • Risk factors • Existing joint disease • Prosthetic joint • Immunosuppresed • Diabetes • Chronic renal disease • Skin infection, cutaneous ulcers • IV drug abuse, alcoholism • Previous intra-articular corticosteroid injection

  7. Septic arthritis • Joint pain, swelling, warmth, and restricted movement • Patient usually has a fever. Not always • Most common (>50%) in knee joint • Wrists, ankles, hips also common • 20% have infection in more than one joint. • Usually haematogenous, eg from endocarditis, UTI, or STD (particularly gonorrhea) Uptodate.com

  8. Haemarthrosis • Presents with considerable swelling • Trauma • Bleeding diatheses • Pigmented villonodular synovitis

  9. Crystal arthropathies

  10. History Marilyn says she has had similar episodes twice in the past 18 months but never this severe and they have settled in 2 or 3 days with some Ibuprofen. She tried two doses over night with no relief.

  11. Examination On examination Marilyn is afebrile and is obviously in significant pain. Your examination of the toe shows a swelling which is localised to the first metatarsophangeal joint of the right great toe. It is red, slightly warm and exquisitely tender to palpation and painful with any attempted passive movement. She is completely unwilling to perform any active movement. 

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