Acute Joint Pain

Question 1

What is a must exclude for acute joint pain and why

Answer 1

Septic arthritis
Can destroy articular cartilage within days if not treated
Associated with a mortality of 10% due to underlying bacteria

Question 2

What are the articular causes of acute joint pain

Answer 2

Trauma
Gout
Pseudogout
Septic arthritis
Seronegative spondyloarthropathy (e.g. ankspond)
Transient synovitis
First presentation of a chronic arthritis
Haemarthrosis
Sarcoidosis, amyloidosis, SLE, vasculitis, rheumatic fever

Question 3

What are the peri-articular and non-articular causes of acute joint pain

Answer 3

Ligament injury 
Tendinitis
Bursitis
Fasciitis
Epicondylitis 

Nerve entrapment
Radiculopathy 
Bone malignancy 
Vasculopathy 
Osteomyelitis 
Neuroma

Question 4

What questions should be asked about acute joint pain

Answer 4

SOCRATES (acute onset - gout/pseudogout/septic arthritis | insidious onset - bursitis/tendonitis | chronic - osteoarthritis)
Any trauma?
Common risk factors for gout - thiazide diuretics, recent heavy alcohol intake, chronic renal failure, chemotherapy
Common risk factors for arthritis - immunosuppression e.g. DM, HIV, steroid use and prosthetic joints
Risk factors for haemarthrosis - haemophilia, warfarin, trauma

Other joints (Sequential involvement -> gonococcus or rheumatic fever | several simultaneously -> chronic polyarthritis e.g. RA, PA