Arthritis of recent onset. A guide to evaluation and initial therapy for primary care physicians

Correct early diagnosis of acute and recent-onset arthritis is important to prognosis. The erosive damage done by rheumatoid arthritis occurs earlier in the disease course than previously realized, and more specific therapies to minimize damage are becoming available. Also, arthritis may be the initial clue to a serious systemic disease. Determining whether one, several, or many joints are affected can narrow the diagnostic possibilities. Arthrocentesis and synovial fluid testing provide much information and should be done at initial evaluation if possible. The presence or absence of fever, rash, family history of joint disease, and exposure to infective organisms can further direct diagnostic studies and treatment. In general, to avoid masking clues, drug therapy should be delayed for mild symptoms until diagnosis is complete.