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Monoarticular Arthritis Update: Current Evidence For Diagnosis And Treatment In The Emergency Department - $30.00
May 2012 (Volume 14, Number 5)
This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category 1 credits, 4 AAFP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.
Nicholas Genes, MD, PhD
Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
Makini Chisolm-Straker, MD
Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
Philip Shayne, MD
Associate Professor, Vice Chair and Program Director, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
Stephen H. Thomas, MD, MPH
George Kaiser Family Foundation Professor & Chair, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
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.
Excerpt from the issue
A middle-aged man with diabetes and hypertension has been waiting patiently to be seen, with a complaint of right knee pain and swelling that has gradually progressed over several hours. There is no history of trauma, recent or remote, but he describes several gout-like episodes of pain in both feet in recent years, which improved with rest and NSAIDs. He was triaged as an ESI4, and the waiting room is packed. Fortunately, the charge nurse comments on how uncomfortable he looks and he is brought into the ED for evaluation. The patient is afebrile, but the knee is hot, beefy red, and swollen. The ED is over-capacity and the patient’s history is reassuring, so you consider keeping him in a chair. But that knee looks impressive and you wonder if your plan is aggressive enough.
Just then, your nurse brings a new patient back to the adjacent room. He is loudly complaining of shoulder pain, a flare-up resulting from a shoulder injury years before. He is 40 and has no other medical problems. “My pain doc usually just gives me a shot, but he’s out of town,” he said. You order a film and 800 mg PO ibuprofen, but you wonder if an intra-articular injection of analgesia and steroids would be better.