Emergency Medicine

Acute Arthropathy

General Medical Emergencies 105

Disease in other cranial structures

DIAGNOSIS AND MANAGEMENT

1 Iritis (see p. 421), otitis media (see p. 399), sinusitis or dental caries may all
present with headache.

2 Treatment is aimed at the underlying condition.

ACUTE ARTHROPATHY

Acute joint pain in the ED may be divided into three main types:
● Acute monoarthropathy
● Acute polyarthropathy
● Periarticular swellings.

Acute monoarthropathy

DIFFERENTIAL DIAGNOSIS

It is important to distinguish between:
● Septic arthritis
● Gout or pseudogout
● Trauma and haemarthrosis
and occasionally:
● Rheumatoid arthritis
● Osteoarthritis.
though these last two are more commonly polyarticular.

Septic arthritis

DIAGNOSIS

1 This may occur with any penetrating trauma, even trivial such as a rose
thorn, or following arthrocentesis.

2 Most cases, however, develop from haematogenous spread. This is predis-
posed to by:
(i) Rheumatoid arthritis.
(ii) Osteoarthritis, particularly in the elderly.
(iii) Intravenous drug abuse.
(iv) Diabetes mellitus.
(v) Immunosuppression.
(vi) Disseminated gonococcal or meningococcal infection.
(vii) Sickle cell disease, often from Salmonella.