Monoarticular Arthritis, Acute

Presentation

The patient complains of one joint that has become acutely red, swollen, hot, painful, and stiff, with pain on minimal range of motion (ROM). Rapid onset with fever and local warmth suggests the possibility of septic arthritis. A prominent monarticular synovitis with comparatively little pain, but where the joint is warm with a large effusion, especially of the knee, is typical of Lyme disease. A migratory tendonitis or arthritis often precedes gonococcal monarthritis. A history of similar attacks, especially of the first metatarsophalangeal joint, suggests the possibility of gouty arthritis. A history of recurrent knee swelling with minimal erythema and gradual onset after overuse or minor trauma is more likely associated with osteoarthritis and pseudogout.

A child between the ages of 3 and 10 years who presents with a limp or inability to walk may have a transient synovitis of the hip or a more serious septic arthritis.