Uzma Rasheed, Abid Zaheer Farooqi, Wajahat Aziz.
Diagnosis of Patients Presenting With Monoarthritis.
Ann Pak Inst Med Sci Jan ;8(1):14-8.

Objective: To determine the final diagnosis of patients presenting with monoarthritis. Place & Duration of Study: Study was conducted at Department of Rheumatology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, between February 2010 and May 2011. Study Design: Descriptive Case Series Materials and Methods: Fifty consecutive patients 16-40 years of age, presenting with monoarthritis were recruited. Patients were interviewed and examined, followed by investigations. Patients were treated according to the initial work up and diagnosis made. If initial work up did not reveal diagnosis, symptomatic treatment was offered. Patients, who showed remission in 4-6 weeks, were not investigated further. In patients with arthritis extending beyond 6 weeks relevant wok up was done to reach the final diagnosis. Patients were followed up till the diagnosis was made. Results: Out of a total of 50 patients there were 56% (n=28) males and 44% (9=22) females. Mean age was 29.6 + 8.4 SD years. Duration of arthritis was less than 6 weeks in 38% (n=19) and more than 6 weeks in 62% (n=31) of patients. Knee was the most commonly involved joint(60%) followed by ankle, wrist, metatarsophalangeal, elbow and hip joints. White blood cell count was not helpful while radiographs and synovial fluid WBC count gave important diagnostic information. MRI of the affected joint and synovial biopsy in selected cases assisted in making diagnosis. 18% patients had osteoarthritis, 36% inflammatory, 14% infective, 8% gout, 4% malignancy related, 6% undifferentiated arthritis, 6% mechanical and 8% had miscellaneous causes Conclusion: In evaluating patients with monoarthritis, precise history, thorough clinical examination, radiographs of joint and synovial fluid examination are of great diagnostic value. MRI and synovial biopsy can be helpful in selected cases. Few cases may still remain undifferentiated despite all investigations.

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