Diagnostic Considerations for Monoarticular Arthritis of the Hand and Wrist

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m i a i p a p t m t ACUTE ONSET OF monoarticular pain and inflammation in the hand and wrist can be a perplexing and frustrating problem for both the cliniian and the patient. Barring a definitive history of rauma, the workup often presents a diagnostic chalenge. Although emphasis should be placed on ruling ut conditions such as sepsis and inflammatory arthropthies that might lead to further tissue destruction, virually any disease associated with arthritic symptoms an begin as a monoarthritis. Workup of these patients hould proceed systematically and efficiently to achieve timely diagnosis, keeping in mind that most diagnoses re made by a combination of findings as opposed to ne pathognomonic element. Key points elicited from the patient history and physcal examination should direct the workup. In particular, lues that might point toward an infectious etiology nclude antecedent sexual risk factors, intravenous drug se, tick bites, immunosuppression (eg, human immuodeficiency virus, diabetes, chemotherapy or radiation, tc) or exotic travel history. Conversely, constitutional igns or symptoms such as stiffness after inactivity, also nown as the gelling phenomenon, urethritis, uveitis, nd skin plaques would point more toward a systemic nflammatory condition. Although many physical ndings are nonspecific, attempts should be made to ifferentiate between articular and nonarticular pain enerators. Findings of tenderness radiating away from joint line, for example, might indicate the presence of oft tissue pathology, such as flexor tenosynovitis. Rouinely, laboratory work should include white cell count WBC), erythrocyte sedimentation rate (ESR), and C-