PRESENTATION OF ATRAUMATIC JOINT SWELLING

1. APPROACH TO A PATIENT WITH
ATRAUMATIC JOINT SWELLING
DR ABDUL RUB PGY1 MEM [NSLIJ]
MISSION HOSPITAL

2. Aim 1. localize the source of the joint swelling and to
determine the type of pain source
• history and physical examination
• Screening laboratory test

3. inflammation
cartilage dégénération,
Crystal déposition
infection

4. POSSIBLE CAUSES OF JOINT SWELLING
1. SEPTIC ARTHRITIS
2. GONOCOCCAL ARTHRITIS
3. RHEUMATOID ARTHRITIS
4. GOUT AND PSEUDO GOUT
5. OSTEOARTHRITIS
6. REACTIVE ARTHRITIS
7. LYME DISEASE

5. 1. Was the onset of joint swelling sudden or gradual
Septic arthritis and crystal-induced arthropathies tend to
present acutely (typically within two weeks) as opposed to
rheumatoid arthritis or osteoarthritis which have a more
insidious onset.
2. How many joints are involved
Gout and septic arthritis generally present as a
monoarthritis (although more than one joint can be
involved), whereas reactive arthritis and rheumatoid
arthritis tend to affect several joints.
3.Which joints are affected?
septic arthritis involves the knee in adults
and the hip in children
In gout up to 70% of attacks first occur in
the big toe .

6. 4.Are there any constitutional symptoms?
• A patient with septic arthritis may have general
malaise and a history of fever and rigor
• A history of a gastrointestinal or genitourinary
infection raises the possibility of reactive arthritis
(Reiter's syndrome).
• Lyme disease, which is associated with a typical
rash (erythema migrans) is often accompanied by
general symptoms of fever, malaise, arthralgia,
myalgia and headache
5.Sudden loss of function?
Sudden loss of function in patients with inflammatory arthritis.

7. So how should we relieve a pain of a patient with a swollen joint?
pain can often be alleviated with the use of simple analgesia or
non-steroidal anti-inflammatories. Sometimes the use of
opiate-based analgesia may be necessary.
Joint aspiration is a quick, often immediate and very effective
method for relieving pain from the swollen joint

8. • Swelling is an important sign of active current
inflammation. It may be due to an effusion in the joint or
oedema of surrounding tissues.
• Swelling over a bursa or tendon indicates inflammation
of that structure and bony swelling would be in keeping
with osteoarthritis.
EXAMINATION

9. • Tenderness should be elicited by gentle palpation over
the affected joint. Point tenderness may be the result of
inflammation in periarticular soft tissue and suggests
bursitis or muscle injury.
• Passive and active ranges of movement are usually
significantly diminished in septic arthritis.
• Also look out for any associated signs of joint disease,
such as rheumatoid nodules or gouty tophi.

10. Septic Arthritis most important diagnostic consideration in acute joint pain
1.Bacterial, Nongonococcal Septic Arthritis
2.Gonococcal Septic Arthritis
Cultures of the posterior pharynx, urethra, cervix, and rectum.

11. Crystal-Induced Synovitis (Gout and Pseudogout)
primarily an illness of middle-aged and elderly adults

13. Imaging
•X-rays
•USG
•CT SCAN
•MRI

16. THANKS