Emergency Medicine Practice: Monoarticular Arthritis Update

Monoarticular arthritis presentations in the emergency department
are increasing as the population ages and gets heavier. Many
etiologies — from trauma to infection to autoimmune-mediated
inflammation — are associated with significant disability or early
mortality, and their treatments are associated with adverse effects.
A systematic approach to evaluating patients with monoarticular
arthritic complaints is important for relieving pain, diagnosing
systemic illness, and unmasking true arthritis emergencies. Septic
arthritis is a rapidly destructive process that can cause significant
disability in a matter of hours or days, with relatively high mortality.
Other causes of monoarticular arthritis may cause disability in the
long term. In all cases, accurate diagnosis and appropriate therapies
are crucial for resuming activities and preventing long-term deficits.
This review examines the diagnosis and treatment of monoarticular
arthritis, with a focus on recent evidence in the diagnosis of septic
arthritis and new research on gout therapies. Modalities for pain
control and new techniques for imaging are discussed.