MANUAL MINORS
Acute arthritis is a condition that arises suddenly, causing inflammation, pain, and stiffness in the joints. From the perspective of an emergency physician in an emergency department, acute arthritis can range in severity from manageable discomfort to a medical emergency.
Initial Evaluation
The emergency physician must conduct a quick and detailed assessment to identify the underlying cause of the acute arthritis, as it can result from various conditions, such as:
Infections: Septic arthritis is a medical emergency requiring immediate treatment. It is characterised by the presence of bacteria in the joint, causing severe inflammation. Patients often present with fever, chills, and intense pain in the affected joint.
Gout: Another common cause of acute arthritis is gout, a metabolic disease where uric acid crystals deposit in the joints, causing inflammation and severe pain. This type of arthritis can begin suddenly, often during the night.
Trauma: Recent joint injuries can trigger an episode of acute arthritis, presenting with swelling and pain in the affected joint.
Exacerbation of a chronic disease: Autoimmune diseases such as rheumatoid arthritis can have acute exacerbations, causing a rapid worsening of symptoms.
Differential Diagnosis
It is crucial to consider a broad differential diagnosis in cases of acute arthritis, including infectious, metabolic, traumatic, and autoimmune causes.
Diagnostic tests that may be useful include blood tests, synovial fluid cultures, X-rays, and, in some cases, ultrasound or MRI scans.
Pathology | Description | Symptoms Similar to Acute Arthritis |
Bursitis | Inflammation of the synovial sacs (bursae) cushioning joints. | Pain, localised swelling, tenderness in the affected area. |
Tendinitis | Inflammation of the tendons connecting muscles to bones. | Joint pain, stiffness, limited movement. |
Cellulitis | Bacterial infection of the skin and subcutaneous tissues. | Inflammation, redness, pain in the affected region. |
Phlebitis or Thrombophlebitis | Inflammation of a vein, often associated with a blood clot. | Pain, swelling, warmth in a limb. |
Osteomyelitis | Infection of the bone. | Intense pain, fever, signs of inflammation in the affected area. |
Sprain or fracture injury | Non-displaced sprain or fracture. | Pain, swelling, limited movement in the affected joint. |
Avascular necrosis | Death of bone tissue due to a lack of blood supply. | Joint pain, swelling, stiffness, especially in the hip. |
Rheumatic fever | Inflammatory disease post-streptococcal infection. | Pain and inflammation in various joints. |
Compartment syndrome | Increased pressure in a muscle compartment. | Intense pain, swelling, sensation of tightness. |
Reiter’s syndrome | Arthritis reactive to an infection elsewhere in the body. | Joint pain and inflammation, acute symptoms. |
Management in the Emergency Department
Initial management focuses on relieving pain, controlling inflammation, and stabilising the patient. Treatment may include:
Analgesia: Administration of pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management.
Drainage: If septic arthritis is suspected, joint aspiration may be needed to analyse the fluid and reduce pressure.
Antibiotics: In cases of septic arthritis, antibiotics must be administered as soon as possible to combat the infection.
Rheumatology consultation: In complex cases, a consultation with a rheumatologist should be considered for more specialised management.
Management
Depending on the underlying cause and the severity of the acute arthritis, the patient may be discharged with outpatient treatment or require hospitalisation.
In severe cases, such as septic arthritis, admission for intensive treatment is necessary.
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