Rheumatology

ACUTE MONOARTHRITIS Some rheumatic diseases present with acute inflam- The patient, through his appearance, behaviour and mation of a single joint. background, supplies diagnostic cues to the physician Causes of acute monoarthritis include: who interprets them according to his own experience * septic arthritis and training. The doctor then forms a hypothesis * traumatic synovitis which may be accepted or rejected as the result of further investigation. At some stage a diagnostic label * haemarthrosis may be applied and appropriate management in- * gout stituted. The response to treatment may itself alter the * pseudogout (pyrophosphate arthropathy) original hypothesis. * seronegative rheumatoid arthritis For some diseases encountered in rheumatology, * Still's disease especially those seen in hospital, this approach may be * psoriatic arthritis appropriate but in many rheumatic conditions it cannot be applied. The condition may be so evan- Acute monoarticular arthritis must be differen- escent or the disability so mild that a full-scale tiated from inflammation of the periarticular struc- investigation, usually negative, is not warranted tures.
Osteomyelitis in the metaphysis of a long bone before treatment is begun. This move from cues to may be confused with infectious arthritis of the management without a firm 'diagnosis' is a technique adjacent joint. Inflammation near but not involving used in good general practice and not an illegitimate the joint usually allows a sm all range of pain-free short cut adopted to save time: frequently it is the only passive movement.