A cute mono arthritis Acute onset of arthritis affecting a
single joint It may be a large weight bearing joint or smaller
e.g The great toe
Main causes
Sepsis
Crystals
Blood
Assess pt for
Predisposing factors for infection
Immunocompromised
IV
drug abuse
Diabetes
Recent infection
Direct penetrating wound
Infectious symptoms
Systemically unwell Fever sweats anorexia malaise THR LBP
At risk recent STI
Features suspicious of Crystals e.g Gout
Previous episodes
Pre disposing factors 7 Excess alcohol diuretic
renal impairment
, Features suspicious of haemarthrosis
Bleeding disorder
Anti coags
Trauma
Investigations
Joint aspiration Gram stain WCC culture crystals
Routine bloods WCC ESR CRP Ute LET
X USS MRI
ray
A Sepsis Septic arthritis
Either Haematogenous spread most common from
other infection e.g UTI RTI of Local spread
local tissue infection penetrating trauma
Pathogens Staph aureus Staph epidermidis N gonnorhoea
Management
IV abx Flucloxacillin t
Benzylpenicillin
6 weeks PO Fusidic acid narrow spectrum
AB X for
staph infection
IV Clindamycin in Penicillin
allergy
Regular joint aspiration lavage
Analgesia rest ICE packs
Thrombo prophylaxis
Surgical washout if failure to improve
single joint It may be a large weight bearing joint or smaller
e.g The great toe
Main causes
Sepsis
Crystals
Blood
Assess pt for
Predisposing factors for infection
Immunocompromised
IV
drug abuse
Diabetes
Recent infection
Direct penetrating wound
Infectious symptoms
Systemically unwell Fever sweats anorexia malaise THR LBP
At risk recent STI
Features suspicious of Crystals e.g Gout
Previous episodes
Pre disposing factors 7 Excess alcohol diuretic
renal impairment
, Features suspicious of haemarthrosis
Bleeding disorder
Anti coags
Trauma
Investigations
Joint aspiration Gram stain WCC culture crystals
Routine bloods WCC ESR CRP Ute LET
X USS MRI
ray
A Sepsis Septic arthritis
Either Haematogenous spread most common from
other infection e.g UTI RTI of Local spread
local tissue infection penetrating trauma
Pathogens Staph aureus Staph epidermidis N gonnorhoea
Management
IV abx Flucloxacillin t
Benzylpenicillin
6 weeks PO Fusidic acid narrow spectrum
AB X for
staph infection
IV Clindamycin in Penicillin
allergy
Regular joint aspiration lavage
Analgesia rest ICE packs
Thrombo prophylaxis
Surgical washout if failure to improve
