emergency medicine at ncemi   More Emergency Medicine Resources
Back to table of contents

9.09 Acute Monarticular Arthritis


Presentation

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

What to do:

What not to do:

Discussion

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.


Table of Contents
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
Longwood Information LLC 4822 Quebec St NW Washington DC 20016-3229
1.202.237.0971 fax 1.202.244.8393 electra@clark.net
Emergency Medicine at NCEMI   More emergency medicine resources
Write to us at NCEMI
Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD