paweł hrycaj, m.d., ph.d. - witamy na stronie ... · pdf filepain and swelling in his left...

Paweł Hrycaj, M.D., Ph.D.

Approach to a patient withmonoarthritis/oligoarthritis

Department of Rheumatology and Clinical Immunology

University School of Medical Sciences, Poznań

Polyarthritis

Monoarthritis Oligoarthritis

Classification of arthritis according to the number of joints involved

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 …

Which conditions should be

taken into account?

Traumatic

lesions

Crystal-induced

arthritisInfection

Most common causes of acute monoarthritis

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

� 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

� 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

� 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

What to do next?

Until infection has been ruled

out, corticosteroids should not

be injected into a joint!

If not contraindicated, i.a.

glucocorticoid injection is

recommended in many patients

with monoarthritis

Common causes of oligoarthrtis

� Reactive arthritis

� Psoriatic arthritis

� Ankylosing spondylitis

� Early rheumatoid arthritis

� Gonococcal arthritis

� Rheumatic fever

� Lyme disease

How to treat

monoarthritis?