Emergency Medicine

ACUTE ARTHROPATHY

108 General Medical Emergencies

(i) Also perform joint aspiration when septic arthritis cannot be

excluded, or refer the patient directly to the orthopaedic team.

MANAGEMENT

1 Give analgesia and refer the patient to the orthopaedic team as necessary.

Management varies according to the joint involved (see Section IX, Ortho-

paedic Emergencies).

2 Give factor VIII to a patient with known haemophilia A, factor IX to a known

haemophilia B patient and von Willebrand’s factor plus factor VIII to a

patient with von Willebrand’s.

(i) Organize this as rapidly as possible in consultation with the

haematology team.

Acute polyarthropathy

DIAGNOSIS

1 There are many causes, including:

(i) Rheumatoid arthritis.

(ii) SLE.

(iii) Psoriatic arthritis.

(iv) Ankylosing spondylitis.

(v) Reiter syndrome.

(vi) Viral illness, e.g. hepatitis B, rubella, parvovirus B19, and HIV.

(vii) Sarcoid.

(viii) Ulcerative colitis, Crohn’s disease, gonococcus (early bacteraemic

phase), Behçet’s disease, and Lyme disease.

(ix) Rheumatic fever, or bacterial endocarditis.

(x) Osteoarthritis, haemochromatosis, acromegaly (all non-

inflammatory).

2 Send blood for FBC, ESR, CRP, ELFTs, uric acid, rheumatoid factor, anti-

nuclear antibody (ANA) and DNA antibodies, viral titres and blood cultures

according to the suspected cause.

3 Request X-rays of the affected joints.

MANAGEMENT

1 Refer to the medical team for admission, bed rest, drug treatment and defini-

tive diagnosis if the patient is systemically unwell.

2 Otherwise, commence an NSAID analgesic such as ibuprofen 200–400 mg

orally t.d.s. or naproxen 250 mg orally t.d.s. and refer the patient to medical

or rheumatology outpatients.