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9.09 Acute Monarticular Arthritis


The patient complains of one joint which has become acutely red, swollen, hot, painful, and stiff.

What to do:

What not to do:


The urgent reason for tapping a joint effusion is to rule out a bacterial infection, which could destroy the joint in a matter of days. Beyond identifying an infection (with Gram stain, culture, and WBC) further diagnosis of the cause of arthritis is not particularly accurate nor necessary to decide on acute treatment. Reducing the volume of the effusion may alleviate pain and stiffness, but this effect is usually short-lived, as the effusion reaccummulates within hours. Identification of crystals is essential for the diagnosis of gout or pseudogout, but one acute attack may be treated the same as another inflammatory arthitis and exact diagnosis deferred to follow up.

Infants and young childen may present with fever and reluctance to walk from septic arthitis of the hip or knee, and arthrocentesis may require sedation or general anesthesia.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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