Reviewed By: Pramod Kerkar, MD, FFARCSI

What is Monoarthritis?

Monoarthritis can be defined as arthritis that involves one joint at one time. There are numerous possible causes of monoarticular arthritis or monoarthritis that includes trauma, infection, nonspecific inflammatory conditions, neoplasm, crystal deposition, and immunologic conditions. The onset of this medical condition is intense and sudden with joint pain, fever, and joint swelling. The presentation of the symptoms needs sudden treatment and diagnosis for preventing joint destruction. The doctor uses the medical history, x-ray, physical examination, synovial fluid exam, and blood tests for determining the causes of monoarticular arthritis. It is mostly associated with the severe condition but can also be the initial symptoms of a polyarthritis. It can be due to periarticular condition or a non-inflammatory joint condition, soft tissue or a bone disease.

Symptoms of Monoarthritis

When monoarthritis develops all of a sudden; fracture, trauma, or loose body is suspected. If monoarthritis develops gradually within one or two days then it is associated with infection, inflammation, or crystal deposition. It pains initially and cannot be recognized, however gradually it worsens within days and weeks. The reason may be osteoarthritis, indolent, or tumor. If the morning stiffness is more along with restricted movement and joint pain then an inflammatory arthritis is suspected. Pain that happens in the periarticular region is related to the disorder of a soft tissue. When monoarthritis is a chronic one then it is associated with an already existing joint disease.

Causes of Monoarthritis

The causes of monoarthritis include the following:

Septic Arthritis:

Septic arthritis is caused because of bacterial infection of the joint. It needs immediate joint washout and intravenous antibiotic therapy for the large joints. Children and the small joints can be treated with intravenous antibiotics and repeated aspirations.

Gout as a Cause of Monoarthritis:

In gout, inflammatory arthritis may be caused by more uric acid either due to under-excretion or due to overproduction. Before reaching menopause, women have a lower incidence than the males; however, the rates become equal after this age. Gout can cause poly or monoarthritis but first results in monoarthritis.

Osteoarthritis:

Osteoarthritis is a disease involving mainly the hips and the knees. When the cartilage that protects the bones from rubbing erodes, osteoarthritis occurs. Osteoarthritis is mainly a polyarthritis though it begins in a single joint before involving the other joints.

Pseudogout as a Cause of Monoarthritis:

When monoarthritis happens due to pseudogout, a calcium pyrophosphate disease, this inflammation remains from days to weeks. It involves the knees in most of the attacks. Just like gout, the attacks can happen with physical trauma, spontaneously, or metabolic stress. Patients feel well between the pseudogout attacks.

Psoriatic Arthritis Causing Monoarthritis:

It happens in 5 to 10 percent of the patients having psoriasis. The classic presentation includes the distal interphalangeal joints. Morning stiffness is there. Dactylitis, deformity of the involved joints, and nail involvement are quite common.

Diagnostic Tests for Monoarthritis

Blood Tests for Diagnosing Monoarthritis:

The blood tests can give important clues. Septic, inflammatory, and crystal type arthritis are normally associated with elevated CRP, elevated sedimentation rate, and a high white blood cell count. The blood tests often determine the systemic disease that tests the liver, kidney, muscle, and bone function.

Imaging Tests to Diagnose Monoarthritis:

The x-rays can show the swelling of the soft tissues, localized bone disease, loose bodies, fracture, calcium in periarticular tissues, and joint destruction. CT scan is advised when the doctors need more details. MRI is the best option to detect the soft tissues. MRI can assess the joint damage and the inflammation, even if they are asymptomatic. Bone scans and arthrography are the other imaging options. Ultrasound is increasingly used in the clinics for diagnosing the arthritic and the soft tissue conditions.

Synovial Fluid Analysis for Diagnosing Monoarthritis:

This is the most important and useful test to evaluate monoarthritis. Synovial fluid is analyzed for its cloudiness and color. The count of white blood cells determines the difference between the inflammatory and the non-inflammatory causes. When the white blood cell count in synovial fluid is more than 2000 WBC/mm3 then it is an inflammatory condition and with lesser than 2000 WBC/mm3, it is non-inflammatory.

Treatment for Monoarthritis

When a person is suffering from monoarthritis, whatever may be its reason, he should give rest to the joint during the acute phase. The symptomatic treatment for monoarthritis is dependent on the anti-inflammatory agents, gastric protection, and analgesics, at a time with the steroids; however, the most important thing is treating the underlying reason of monoarthritis. The patient should be admitted to a hospital if there is a usual malaise attributed to this disease, positive Gram stain, synovial fluid along with the inflammatory conditions, plus fever, and radiological bone lesion.

The objective of the treatment for monoarthritis is to give relief to the pain, prevent further attacks, and reduce the inflammation. The maximum dosages of the oral anti-inflammatory drugs are used along with antacids for monoarthritis. Glucocorticoids are used for treatment; the prednisone dosages are 30-50 mg per day. Great care for dosages is highly important for the acute pain. The monoarthritis patient should not change or remove the earlier scheduled dosages of treatment as it may aggravate the thing. In order to prevent the future attacks, patients are advised to modify their lifestyles, with no alcohol, low-purine diet, and healthy physical exercises.

Conclusion

With the growth in population, the patients with monoarthritis are increasing. A systematic approach should be used to evaluate the patients suffering from monoarthritis and this is important to relive the pain. Appropriate therapies and accurate diagnosis are important to resume the activities and to prevent the long-term deficits.

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: November 8, 2018

This article does not provide medical advice. See disclaimer

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