One joint affected by pain, swelling, overlying redness, stiffness and local heat
Monoarthritis
One joint affected by pain, swelling, overlying redness, stiffness and local heat (±fever).
| Acute septic arthritis | Suggested by: extremely painful, hot red joint, high fever. |
| Confirmed by: increased WBC. Joint aspiration: synovial fluid turbid. Culture growing staphylococcus or streptococcus or pseudomonas or gonococci or TB, etc. | |
| Gout | Suggested by: one acutely inflamed joint (usually small esp. big toe) at a time, but other joints in hands, arms, legs, and feet deformed. Tophi on ears and tendon sheaths. |
| Confirmed by: serum urate Increase (not always). Urate crystals (negatively birefringent in plane-polarised light) present on joint aspiration. | |
| Pseudogout (Ca2+ pyrophosphate arthropathy/ chondrocalcinosis) | Suggested by: one painful joint (usually knee) especially in elderly or history of hyperparathyroidism or myxoedema or osteoarthritis or haemochro-matosis or acromegaly. |
| Confirmed by: joint aspiration: synovial crystal deposits positively bifringent in plane-polarised light. | |
| Reiter's disease | Suggested by: monoarthritis, urethritis, conjunctivitis especially in a young man or a history of diarrhoea (dysentery). Also suggested by associated iritis, keratoderma blenorrhagica (brown, aseptic abscesses on soles and palms), mouth ulcers, circinate balanitis (painless serpiginous penile rash), plantar fasciitis, achilles tendonitis, and aortic incompetence. |
| Confirmed by: rheumatoid factor -ve (i.e. seronegative). Urinalysis: 1st glass of a 2-glass urine test shows debris in urethritis. | |
| Traumatic haemarthrosis | Suggested by: acutely inflamed joint after trauma. |
| Confirmed by: joint aspiration: aspiration of blood from joint. | |
| Psoriasis | Suggested by: acutely inflamed terminal interphalyngeal or I-P) joint but other joints deformed especially terminal I-P joints and pitting and thickening of fingernails. |
| Confirmed by: psoriatic plaques on elbows and extensor surfaces of limbs, scalp, behind ears and around navel. Rheumatoid factor -ve (i.e. seronegative). | |
| Rheumatoid arthritis | Suggested by: Early morning stiffness. Fingers: swan neck or boutonnire deformities. Thumbs have Z-deformities. MCP joints and wrists: sublux acquiring ulnar deviation. Knees: valgus or varus deformity and poplitealBaker's cysts. Feet: Subluxation of metatarsal heads with hallux valgus, clawed toes, and callouses. |
| Confirmed by: Rheumatoid factor +ve (i.e. seropositive), anti-IgG autoantibody. FBC: Normochromic anaemia, ESR when active. | |
| Leukaemic joint deposits | Suggested by: acutely inflamed joint. |
| Confirmed by: leukaemic picture on peripheral film and bone marrow. | |
| Reactive arthritis (aseptic) | Suggested by: asymmetric mono- or oligoarthritis developing about 1 week after infection elsewhere. |
| Confirmed by: Lab evidence of venereal or enteric infection, Yersinia, Chlamydia trachomatis, Campylobacter, Salmonella/Shigella and Chl. pneumoniae, HIV, Vibrio parahaemolyticus, Borrelia burgdorferi, Clostridium difficile. |
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