APPROACH TO A PATIENT WITH ATRAUMATIC JOINT SWELLING

DR ABDUL RUB PGY1 MEM [NSLIJ]

MISSION HOSPITAL

Aim 1.  localize the source of the joint swelling and to determine the type of pain source

• history and physical examination

• Screening laboratory test 

inflammation cartilage dégénération,

Crystal déposition

infection

POSSIBLE CAUSES OF JOINT SWELLING

1. SEPTIC ARTHRITIS

2. GONOCOCCAL ARTHRITIS

3. RHEUMATOID ARTHRITIS

4. GOUT AND PSEUDO GOUT

5. OSTEOARTHRITIS

6. REACTIVE ARTHRITIS

7. LYME DISEASE

1. Was the onset of joint swelling sudden or gradual

Septic arthritis and crystal-induced arthropathies tend to present acutely (typically within two weeks) as opposed to rheumatoid arthritis or osteoarthritis which have a more insidious onset.

2. How many joints are involved

 Gout and septic arthritis generally present as a monoarthritis (although more than one joint can be involved), whereas reactive arthritis and rheumatoid arthritis tend to affect several joints.

3.Which joints are affected? septic arthritis involves the knee in adults and the hip in children In gout up to 70% of attacks first occur in the big toe . 

4.Are there any constitutional symptoms?• A patient with septic arthritis may have

general malaise and a history of fever and rigor

• A history of a gastrointestinal or genitourinary infection raises the possibility of reactive arthritis (Reiter's syndrome).

• Lyme disease, which is associated with a typical rash (erythema migrans) is often accompanied by general symptoms of fever, malaise, arthralgia, myalgia and headache

5.Sudden loss of function?  Sudden loss of function in patients with inflammatory arthritis.

So how should we relieve a pain of a patient with a swollen joint?

pain can often be alleviated with the use of simple analgesia or non-steroidal anti-inflammatories. Sometimes the use of opiate-based analgesia may be necessary.

Joint aspiration is a quick, often immediate and very effective method for relieving pain from the swollen joint

• Swelling is an important sign of active current inflammation. It may be due to an effusion in the joint or oedema of surrounding tissues.

• Swelling over a bursa or tendon indicates inflammation of that structure and bony swelling would be in keeping with osteoarthritis.

EXAMINATION

• Tenderness should be elicited by gentle palpation over the affected joint. Point tenderness may be the result of inflammation in periarticular soft tissue and suggests bursitis or muscle injury.

• Passive and active ranges of movement are usually significantly diminished in septic arthritis.

• Also look out for any associated signs of joint disease, such as rheumatoid nodules or gouty tophi.

Septic Arthritis most important diagnostic consideration in acute joint pain

1.Bacterial, Nongonococcal Septic Arthritis

2.Gonococcal Septic Arthritis

Cultures of the posterior pharynx, urethra, cervix, and rectum.

Crystal-Induced Synovitis (Gout and Pseudogout)

primarily an illness of middle-aged and elderly adults

Imaging•X-rays

•USG

•CT SCAN

•MRI

THANKS