Patterns of presentation of arthritis

Monoarthritis

• Septic arthritis
• Crystal arthritis (gout, CPPD)
• Osteoarthritis
• Trauma e.g. haemarthrosis

Oligoarthritis (< or = 5 joints)

• Crystal arthritis
• Psoriatic arthritis
• Reactive arthritis (eg. Yersinia, Salmonella, Campylobacter)
• Ankylosing spondylitis
• Osteoarthritis

Polyarthritis (>5 joints involved)

• Symmetrical
• Rheumatoid arthritis
• Osteoarthritis
• Viruses (e.g. hepatitis A, B and C; mumps)
• Systemic conditions
• Asymmetrical
• Reactive arthritis
• Psoriatic arthritis
• Systemic conditions

ALWAYS EXCLUDE SEPTIC ARTHRITIS IN ANY ACUTELY INFLAMED JOINT, AS IT CAN DESTROY A JOINT IN UNDER 24 hours. INFLAMMATION MAY BE LESS OVERT IF IMMUNOCOMPROMISED (e.g. STEROIDS) or if there is underlying joint disease. JOINT ASPIRATION IS THE KEY INVESTIGATION, AND IF YOU ARE UNABLE TO DO IT, FIND SOMEONE WHO CAN.

HOWEVER, IF YOU GO AND ASPIRATE IN A FRACTURE YOU TURN AN OPEN FRACTURE TO FRACTURE.