paweł hrycaj, m.d., ph.d. - witamy na stronie ... · pdf filepain and swelling in his left...
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Paweł Hrycaj, M.D., Ph.D.
Approach to a patient withmonoarthritis/oligoarthritis
Department of Rheumatology and Clinical Immunology
University School of Medical Sciences, Poznań
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Polyarthritis
Monoarthritis Oligoarthritis
Classification of arthritis according to the number of joints involved
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A-K, a 40-year old male patient came
to his family doctor because of severe
pain and swelling in his left knee.
There was no history of any trauma to
the joint. On physical examination
swelling of the joint and effusion was
present …
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Which conditions should be
taken into account?
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Traumatic
lesions
Crystal-induced
arthritisInfection
Most common causes of acute monoarthritis
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Potential causes of acute monoarthritis
• Crystal-induced
• Infectious arthritis
� Bacteria/Fungi
� Mycobacteria/Viruses
� Lyme disease
• Overuse Trauma
• Osteoarthritis
• Hemarthrosis
• Internal derangement
• Osteomyelitis
• Avascular necrosis of bone
• Bone malignancies
• Bowel-disease-associated arthritis
• Hemoglobinopathies
• Juvenile arthritis
• Loose body
• Psoriatic arthritis
• Rheumatoid arthritis
• Reactive arthritis
• Sarcoidosis
• Amyloidosis
• Behçet's syndrome
• Familial Mediterranean fever
• Foreign-body synovitis
• Hypertrophic pulmonary osteoarthropathy
• Intermittent hydrarthrosis
• Pigmented villonodular synovitis
• Relapsing polychondritis
• Still's disease
• Synovioma
• Synovial metastasis
• Vasculitic syndromes
Common Less common Rare
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� Sudden onset of pain in
seconds or minutes
� Onset of pain over several
hours or one to two days
� Insidious onset of pain over
days to weeks
� Intravenous drug use,
immunosuppression
� Previous acute attacks in any
joint, with spontaneous
resolution
Diagnostic Clues in Patients Presenting with Joint Pain (1)
Fracture, internal
derangement
trauma, loose body
Infection, crystal deposition
disease, other inflammatory
arthritic condition
Indolent infection, osteoarthritis,
infiltrative
disease, tumor
Septic arthritis
Infection, crystal deposition
disease, other inflammatory
arthritic condition
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� Recent prolonged course of
corticosteroid therapy
� Coagulopathy, use of
anticoagulants
� Urethritis, conjunctivitis,
diarrhea, and rash
� Psoriatic patches or nail
changes such as pitting
� Use of diuretics, presence of
tophi, history of renal stones
or alcoholic binges
Diagnostic Clues in Patients Presenting with Joint Pain (2)
Infection, avascular necrosis
Hemarthrosis
Reactive arthritis
Psoriatic arthritis
Gout
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� Eye inflammation, low back pain
� Young adulthood, migratory
polyarthralgias, inflammation of the
tendon sheaths of hands and feet,
dermatitis
� Hilar adenopathy, erythema nodosum
Diagnostic Clues in Patients Presenting with Joint Pain (3)
Ankylosing spondylitis
Gonococcal arthritis
Sarcoidosis
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What to do next?
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Until infection has been ruled
out, corticosteroids should not
be injected into a joint!
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If not contraindicated, i.a.
glucocorticoid injection is
recommended in many patients
with monoarthritis
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Common causes of oligoarthrtis
� Reactive arthritis
� Psoriatic arthritis
� Ankylosing spondylitis
� Early rheumatoid arthritis
� Gonococcal arthritis
� Rheumatic fever
� Lyme disease
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How to treat
monoarthritis?