Diagnosis and Management of Acute Joint Pain in the Emergency Department -
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Publication Date: January 2022 (Volume 24, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 01/01/2025.

Authors

Rachel Sullivan, MD

Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Peer Reviewers

Jared Ham, MD

Department of Emergency Medicine, Department of Neurology and Neurocritical Care, University of Cincinnati Medical Center, Cincinnati, OH

John Kiel, DO, MPH, CAQSM

Assistant Professor of Emergency Medicine, Assistant Professor of Sports Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL

Abstract

Acute monoarticular and polyarticular joint pain that results from infection, trauma, and autoimmune and inflammatory processes are a major cause of disability that is often preventable with early diagnosis and management. Septic arthritis presents a particular danger, with a high potential for morbidity and mortality. This issue presents an overview of the various types of acute joint pain that present to the emergency department, and outlines systematic, evidence-based strategies for diagnosis and treatment. Emerging infectious and reactive causes of arthritis, including Zika, chikungunya, and COVID-19 are reviewed. Best-practice recommendations for treatment and disposition based on diagnosis are highlighted.

Case Presentations

CASE 1

A 43-year-old man has arrived by ambulance with complaints of severe pain in his right ankle and left knee…

He is unable to ambulate. There is no history of trauma, travel, or rash.
You wonder why the patient called EMS for joint pain, but then you see his vital signs: 116 beats/min pulse, 39.2°C temperature, 100/70 mm Hg blood pressure, 22 breaths/min respiration, and pulse ox 98% on room air.
You wonder whether you should tap the joints and start empiric antibiotics...

CASE 2

A 27-year-old woman is brought into the nonacute area of the ED with complaints of severe, diffuse joint pain…

She returned last week from the Dominican Republic, where she was on her honeymoon. She also describes subjective fevers.
Her temperature is 37.7ºC; blood pressure, 130/75 mm Hg; and respiratory rate, 18 breaths/min.
The nurse approaches you with the concern that the patient has a diffuse rash and asks whether the patient should be put into isolation...

CASE 3

A 19-year-old woman presents with joint pain and swelling, most noticeably in her feet and toes…

She said she has had some difficulty walking. Her history is significant for a recent upper respiratory infection, with sore throat and headache, 3 weeks ago.
Her temperature is 37ºC; blood pressure, 110/70 mm Hg; and respiratory rate, 20 breaths/min.
You wonder whether her joint pain could be related to the upper respiratory infection...

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