Monoarticular Arthritis Article

Content

• Gout: Diagnosis And Management
• New Gout Guidelines May Leave Gaps
• Can Pseudogout Be Prevented Or Avoided?
• Risk Factors
• Clinical Presentation
• Treatment

Warmth and swelling over a joint can be palpated through a physical exam and are hallmark signs of synovitis. Late stages of Lyme disease can also present as monoarticular arthritis and frequently involves the knee joint. Lyme serology is necessary for the diagnosis because synovial or tissue culture is always negative. Certain viruses like hepatitis B, hepatitis C, parvovirus, Epstein Barr virus , human immunodeficiency virus , alphavirus (e.g., chikungunya virus) and Zika virus can manifest with monoarticular arthritis/ arthralgia. Most viral illnesses are self-limited; however, travel history, vaccination status, and targeted serology may be indispensable to rule out serious medical conditions like HIV and hepatitis. Aggregates have also been defined in the literature and are believed to be deposits of crystals in the soft tissues, which are not large enough to be defined as a tophus.

Gout: Diagnosis And Management

In patients with renal insufficiency, the allopurinol dosage should be adjusted based on the estimated creatinine clearance. Approximately 2 to 5 percent of patients taking allopurinol have minor rashes and other adverse effects. These agents decrease the serum uric acid level by increasing renal excretion. Probenecid and sulfinpyrazone are used in patients who are considered underexcretors of uric acid.

New Gout Guidelines May Leave Gaps

According to the release, 2,104 COVID-19 patients were randomly assigned to take 6 mg of dexamethasone daily for 10 days while another 4,321 were given the usual care. About a month later, it seems that patients who had been in severe respiratory distress seemed to have benefitted greatly from this drug. Corticosteroids are prescribed for a wide variety of conditions, ranging from eczema and asthma to rheumatoid arthritis and lupus. Now a new UK study suggests that giving a corticosteroid called dexamethasone to severely ill COVID-19 patients greatly improves their chances of survival.

All NSAIDs can have serious gastrointestinal side effects, including bleeding and ulceration. These drugs should therefore be used with caution in patients with a history of peptic ulcer disease, congestive heart failure or chronic renal failure. Discretion should be used in giving NSAIDs to patients who are allergic to aspirin or have asthma or nasal polyps. Sulfinpyrazone , another uricosuric agent, is preferred by some physicians because of its added antiplatelet effects. Therapy is initiated at a dosage of 50 mg three times a day, which is gradually increased until the serum urate level is lowered.

Corticosteroids are also used for the treatment of gout pain, both orally and by injection into the affected joint. Doctors do not usually have much difficulty telling gout and rheumatoid arthritis apart. This is because attacks of gout are usually clear-cut with dramatic, intense joint pain. This is in contrast to RA where the pain tends to be more insidious in onset.

Can Pseudogout Be Prevented Or Avoided?

Podagra is suspected if risk factors are present, and a person has an acute attack of pain in the joint of the big toe. "There are a number of recommended interventions that are not opioids to choose from, and topical NSAIDs should be the first line of treatment." Treatment can relieve the symptoms of pseudogout and slow or prevent damage to your joints. Unfortunately, no treatment can get rid of the crystal deposits that cause pseudogout.

Gout can lead to joint damage/deformity, tophi, kidney stones, and renal failure. Erosions are defined as intra- and/or extra-articular discontinuity of the bone surface in two perpendicular planes . These lesions are usually rounded or oval-shaped in gout and have a sclerotic rim causing a “punched-out” appearance and frequently with overhanging edges. Bony erosions, as well as the overhanging edges, are caused by the expansion of the tophus into the bony with new bone formation. The most frequently involved site for gout is the first metatarsophalangeal joint. Erosions are more common with increased age, chronic gout, increased number of tophi, and synovial hypertrophy .

Although flares still occurred, their frequency was reduced even in absence of colchicine coverage, so this approach may also be of benefit for individuals with significant contraindications to colchicine or NSAIDs. In African-American subjects, the primary endpoint was reached in 47% on febuxostat 40 mg/day, 68% on febuxostat 80 mg/day, and 43% on allopurinol. Adverse event rates in both subgroups were comparable with those in the overall trial. When comorbid conditions limit the use of NSAIDs or colchicine, a preferred option may be an intra-articular steroid injection, particularly when a large, easily accessible joint is involved. These findings echo those of other studies and emphasize the importance of providing close coverage, patient education, and prophylaxis against gout flares, especially during the first year of urate-lowering therapy.

Ultrasonography, magnetic resonance imaging, and computed tomography are typically not necessary for diagnosis. Carditis is the major cardiac manifestation of acute rheumatic fever, occurring in 50% to 70% of first episodes, and is associated with valvulitis. Clinical signs of carditis include cardiomegaly, new onset heart murmur , pericardial friction rub, pericardial effusion, and congestive heart failure.

Intravenous administration has been associated with an increased risk of toxic side effects, including bone marrow suppression and renal or hepatic cell damage. Acute gouty nephropathy usually results from the massive malignant cell turnover that occurs with the treatment of myeloproliferative or lymphoproliferative disorders. The blockage of urine flow secondary to the precipitation of uric acid in the collecting ducts and ureters can lead to acute renal failure. Attacks usually start during the night, and moderate pain in a joint is first noticed. The pain becomes persistently worse and has a continuous, gnawing quality.

Intracellular monosodium urate crystal viewed under a polarized light microscope and a conventional light microscope . Gouty tophi involving the proximal interphalangeal joint with erythema of the overlying skin.

Acr Publishes Guidelines For Pharmacologic And Nonpharmacologic Treatment Of Gout

When the local solubility limits of uric acid are exceeded, monosodium urate crystal deposition in the joints, kidneys, and soft tissues causes clinical manifestations, including arthritis, soft tissue masses (i.e., tophi), nephrolithiasis, and urate nephropathy. Asymptomatic hyperuricemia is common and usually does not lead to clinical gout. Three treatments currently available for acute gouty arthritis attacks are nonsteroidal anti-inflammatory drugs , colchicine and corticosteroids.

CaroMont Health’s expertise in a diverse range of medical specialties helps us care for you from head to toe. Our experienced team of doctors, nurses and clinicians is proud to provide innovative, comprehensive healthcare and wellness programs in Gaston County and the surrounding area. The mission of the AAFP is to improve the health of patients, families, and communities by serving your needs with professionalism and creativity. Plain radiograph of the right knee in a 78 year old man with prosthetic joint infection 10 years after initial surgery. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

At night, water is reabsorbed from the joint spaces, leaving a supersaturated concentration of monosodium urate. Hyperuricemia is defined as a serum uric acid concentration above 7 mg per dL (420 μmol per L). This concentration is also the limit of solubility for monosodium urate in plasma. At levels of 8 mg per dL (480 μmol per L) or greater, monosodium urate is more likely to precipitate in tissues. At a pH of 7, more than 90 percent of uric acid exists as monosodium urate.

Strongly negative birefringent, needle-shaped crystals diagnostic of gout obtained from acutely inflamed joint. Fernandes EA, Lopes MG, Mitraud SA, Ferrari AJ, Fernandes AR. Ultrasound characteristics of gouty tophi in the olecranon bursa and evaluation of their reproducibility. Documented gout occurred in 1731 study subjects during 26 years of follow-up. Rheumatology or orthopedic consultation is indicated for any patient with septic arthritis or for any patient in whom a septic arthritis cannot be ruled out. Stepwise introduction of febuxostat—10 mg/day for 4 weeks, then 20 mg/day for 4 weeks, then 40 mg/day—was found to reduce gout flares, in randomized open-label comparative study by Yamanaka et al.