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[Gonarthritis: diagnosis and therapy]
1Rheumaklinik, Universitätsspital Zürich.
Praxis
|September 10, 1996
Summary
A swollen knee requires urgent evaluation to rule out infectious arthritis. Synovial fluid analysis guides diagnosis, distinguishing infection from inflammatory conditions like osteoarthritis.
Area of Science:
- Rheumatology
- Emergency Medicine
- Microbiology
Background:
- The acutely swollen and tender knee joint is a common rheumatologic emergency.
- Prompt diagnosis is crucial to differentiate infectious arthritis from other causes.
Observation:
- Initial evaluation involves synovial fluid analysis for color, clarity, viscosity, and cell count.
- Opaque or purulent fluid necessitates cultures, Gram stain, acid-fast stains, and crystal analysis.
Findings:
- Noninflammatory fluid (clear, highly viscous) with <2000 WBC/mm³ makes infectious arthritis unlikely.
- Osteoarthritis is the most common cause of noninflammatory joint fluid.
- Spondyloarthropathy may be indicated by axial skeleton, tendon, skin, and mucosal changes.
Implications:
- Early identification of infectious arthritis ensures timely antibiotic treatment, preventing joint damage.
- Distinguishing between infectious and inflammatory arthritis guides appropriate management, such as NSAID therapy for osteoarthritis.
- Comprehensive synovial fluid analysis is key to effective rheumatologic emergency care.