One of the most concerning causes in a patient with monoarticular arthritis is septic arthritis. Monoarticular arthritis has a wide range of potential etiologies, ranging from benign to life-threatening. Monoarticular arthritis is a common presentation to the emergency department (ED) and major cause of disability in the United States.
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It is essential for the emergency clinician to be aware how to diagnose and treat these mimics. While monoarticular arthritis can be due to septic arthritis, other medical and surgical conditions present similarly and require different management. Clinicians should consider mimics, such as abscess, avascular necrosis, cellulitis, crystal-induced arthropathies, Lyme disease, malignancy, osteomyelitis, reactive arthritis, rheumatoid arthritis, and transient synovitis. Management includes intravenous antibiotics and orthopedic surgery consult for operative management vs. Blood testing and imaging may assist with the diagnosis, but the gold standard is joint aspiration. Fever is present in many patients, though most are low grade. Septic arthritis commonly presents with monoarticular joint pain with erythema, warmth, swelling, and pain on palpation and movement. This narrative review presents the emergency medicine evaluation and management, as well as important medical conditions that may mimic this disease. However, the differential diagnosis can be broad with conditions that mimic this disease and require different evaluation and treatment. Septic arthritis is a dangerous medical condition associated with significant morbidity and mortality.
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