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Arthritis In The ED: Detecting High-Risk Etiologies And Providing Effective Pain Management

October 2004

Abstract

Acute arthritis and acute exacerbations of chronic arthritis are commonly seen in the ED, especially given the aging population. The emergency physician can almost always play an important role in controlling the patientís pain. Yet there are myriad causes of arthritis, some of which are high-risk and for which rapid identification is essential to prevent catastrophic outcomes. The most urgent priority in the ED encounter is ruling out such causes.

Septic arthritis is a true medical emergency. This rapidly destructive joint disease can destroy a joint within hours to days. Despite the advances in antimicrobial agents and improved methods of joint drainage over the past 25 years, irreversible loss of joint function still occurs in 25%-50% of patients, and the case fatality rate remains high, ranging from 5% to 15%.1

Emergency physicians cannot afford to miss a septic joint, and for this reason, it is important to understand how to differentiate this medical emergency from all other causes of acute arthritis that present to the ED. The spectrum of diseases that cause joint pain is extremely wide, making this task even more difficult. This article provides a comprehensive approach to the management of the adult patient with acute arthritis, including initial assessment, differential diagnosis, the utility of diagnostic testing, arthrocentesis techniques, and, finally, treatment and disposition.

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