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.
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Following are the most informative references cited in this paper, as determined by the authors.
3. * Carpenter CR, Schuur JD, Everett WW, et al. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-796. (Systematic review) DOI: 10.1111/j.1553-2712.2011.01121.x
6. * Long B, Koyfman A, Gottlieb M. Evaluation and management of septic arthritis and its mimics in the emergency department. West J Emerg Med. 2019;20(2):331-341. (Review) DOI: 10.5811/westjem.2018.10.40974
24. * Margaretten ME, Kohlwes J, Moore D, et al. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478-1488. (Systematic review; 14 studies, 6242 patients) DOI: 10.1001/jama.297.13.1478
31. * Coakley G, Mathews C, Field M, et al. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford). 2006;45(8):1039-1041. (Practice guideline) DOI: 10.1093/rheumatology/kel163a
36. * Punzi L, Oliviero F. Arthrocentesis and synovial fluid analysis in clinical practice: value of sonography in difficult cases. Ann N Y Acad Sci. 2009;1154:152-158. (Review) DOI: 10.1111/j.1749-6632.2009.04389.x
61. * Terkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060-1068. (Randomized controlled trial; 184 patients) DOI: 10.1002/art.27327
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Keywords: arthritis, joint, monoarticular, polyarticular, autoimmune, reactive, gout, Zika, Lyme, chikungunya, COVID-19, osteoarthritis, rheumatoid, septic, infectious, osteomyelitis, gonococcal, crystal, bursitis, arthrocentesis, synovial, antibiotics
Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the December 2021 issue of Emergency Medicine Practice: Thoracic Aortic Syndromes in The Emergency Department: Recognition and Management
Rachel Sullivan, MD
Jared Ham, MD; John Kiel, DO, MPH, CAQSM
January 1, 2022
January 31, 2025
Date of Original Release: January 1, 2022. Date of most recent review: December 10, 2021. Termination date: January 1, 2025.
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