Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Patients Presenting with a Hot, Swollen Joint: A Single-Centre Retrospective Analysis

Author(s): Emanuele Chisari *, Khaled M. Yaghmour , Fidel Peat and Wasim Khan

Volume 16, Issue 1, 2020

Page: [38 - 42] Pages: 5

DOI: 10.2174/1573397115666190122113659

Price: $65

Abstract

Background: A hot, swollen joint is a common clinical condition encountered in the ED and elective orthopaedic and rheumatology clinics. These patients can be difficult to manage and properly treat.

Aims and Objectives: The aim of this study was to report a single centre retrospective analysis of patients presenting to our institution for a hot, swollen joint over a three-month period.

Methods: The study included patients presenting with a hot, swollen joint to ED or electively to clinics. The synovial fluid was aspirated and sent for microbiological and cytological investigation. P value was set to < 0.001. 36 patients (22 M, 14 F) with a mean age of 72.8 ± 17.4 years met our criteria. 20 cases (55.6 %) involved the knee joint, the wrist in 10 cases (27.8%), the elbow in 3 cases (8.3%) and the shoulder in 3 cases (8.3%).

Results: Of the 36 synovial fluid samples collected, only 7 (19.4%) reported evidence of infection. On cytological examination of the synovial fluid, 21 (58.3%) reported presence of calcium pyrophosphates crystals (Pseudogout), 4 (11.1 %) reported presence of uric acid crystals (Gout) and 11 (30.5%) reported absence of crystals. We found a significant correlation between age and the diagnosis of pseudogout and between previous antibiotic treatment and ED presentation. Our study sheds light on the high incidence of crystal-related pathologies.

Conclusion: In order to improve our management of this common condition and enhance our understanding of the clinical diagnosis in certain patient population, further high-profile clinical studies are needed.

Keywords: Hot joint, swollen joint, crystal arthropathies, pseudogout, gout, monoarthritis.

« Previous Next »
[1]
Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: What is the cause of my patient’s painful swollen joint? Can Med Assoc J 2009; 06180(1): 59-65.
[http://dx.doi.org/10.1503/cmaj.080183]
[2]
Reed MJ, Carachi A. Management of the nontraumatic hot swollen joint. Eur J Emerg Med 2012; 19(2): 103-7.
[http://dx.doi.org/10.1097/MEJ.0b013e328348d8f8] [PMID: 21730866]
[3]
Becker JA, Daily JP, Pohlgeers KM. Acute monoarthritis: diagnosis in adults. Am Fam Physician 2016; 94(10): 810-6.
[PMID: 27929277]
[4]
Louthrenoo W, Sukitawut W. Calcium pyrophosphate dihydrate crystal deposition: a clinical and laboratory analysis of 91 Thai patients. J Med Assoc Thai 1999; 82(6): 569-76.
[PMID: 10443078]
[5]
Hamilton LC, Biant LC, Temple LN, Field RE. Isolated pseudogout diagnosed on hip arthroscopy. J Bone Joint Surg Br 2009; 91(4): 533-5.
[http://dx.doi.org/10.1302/0301-620X.91B4.21707] [PMID: 19336817]
[6]
Kocyigit F, Kuyucu E, Kocyigit A. Monoarticular hip involvement in pseudogout. Case Rep Rheumatol 2015; 2015302389
[http://dx.doi.org/10.1155/2015/302389] [PMID: 25838961]
[7]
Muangchan C, Bhurihirun T. An investigation of the independent risk factors that differentiate gout from pseudogout in patients with crystal-induced acute arthritis: a cross-sectional study. Rheumatol Int 2018; 38(1): 89-95.
[http://dx.doi.org/10.1007/s00296-017-3891-2] [PMID: 29214345]
[8]
Farah Z, Reddy V, Matthews W, Giles I. Poor adherence to guidelines on early management of acute hot swollen joint(s): an evaluation of clinical practice and implications for training. Int J Clin Pract 2015; 69(5): 618-22.
[http://dx.doi.org/10.1111/ijcp.12580]
[9]
Schumacher HR. Crystal-induced arthritis: an overview. Am J Med 1996; 100(2A): 46S-52S.
[http://dx.doi.org/10.1016/S0002-9343(97)89546-0] [PMID: 8604727]
[10]
Harrold LR, Yood RA, Mikuls TR, et al. Sex differences in gout epidemiology: evaluation and treatment. Ann Rheum Dis 2006; 65(10): 1368-72.
[http://dx.doi.org/10.1136/ard.2006.051649] [PMID: 16644784]
[11]
Richette P, Bardin T, Doherty M. An update on the epidemiology of calcium pyrophosphate dihydrate crystal deposition disease. Rheumatology (Oxford) 2009; 48(7): 711-5.
[http://dx.doi.org/10.1093/rheumatology/kep081] [PMID: 19398486]
[12]
Maravic M, Ea H-KK. Hospital burden of gout, pseudogout and other crystal arthropathies in France. Joint Bone Spine 2015; 82(5): 326-9.
[http://dx.doi.org/10.1016/j.jbspin.2015.01.011] [PMID: 25881756]
[13]
Abhishek A. Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr Opin Rheumatol 2016; 28(2): 133-9.
[http://dx.doi.org/10.1097/BOR.0000000000000246] [PMID: 26626724]
[14]
Dalbeth N, Merriman TR, Stamp LK. Gout 2016; 388(1055): 2039-52.
[15]
Rho Y H, Zhu Y, Zhang Y, Reginato A M, Choi H K. Risk factors for pseudogout in the general population 2012; 51(11): 2070-4 2012
[http://dx.doi.org/10.1093/rheumatology/kes204]

Rights & Permissions Print Cite
Article Metrics
6
© 2024 Bentham Science Publishers | Privacy Policy