Stephen Ray Mitchell and John F. Beary, III
Acute monarthritis Chronic., monarthritis Acute .polyarthritis Chronic polyarthritis
The number of joints and the time course during which a joint disorder develops guide the approach to differential diagnosis. Acute monarthritis may represent septic arthritis, which is a rheumatologic emergency. Prompt diagnosis and treatment of a potentially septic process are required. The single abnormal joint that persists beyond 2 months presents a different diagnostic challenge. In each case, one must view the overall clinical presentation, including factors such as associated extraarticular visceral involvement, constitutional signs and symptoms, severity of illness and limitation of function, potential foci of infection, skin lesions, hyperuricemia, and history of trauma or bleeding disorders. Usually, an aggressive initial approach is indicated, including joint aspiration with synovial fluid analysis and occasionally referral for synovial biopsy or arthroscopy. Therapy will vary significantly depending on the presumptive diagnosis. Specific therapy of each disease is discussed in later chapters. T§ble.,.„9:1 and TabJe.9-2 summarize the diagnostic approach to this group of disorders.
Table 9-1. Differential diagnosis of monarthritis by presentation
Table 9-2. Differential diagnosis of polyarthritis by presentation
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