Day 1- Approach to Acute Monoarthritis

Approach to Acute Monoarthritis (CMAJ)

Must rule out septic arthritis !

• If there is a concern for septic joint, administer empiric antibiotics (ceftriaxone 2g IV + vancomycin 1g IV) and preform arthrocentesis

Gout/CPPD:

• Acute management:

  • NSAIDs: naproxen 500mg PO BID until acute episode resolves + colchicine 1.2mg PO once then 0.6mg PO BID (d/c 2-3 days after episode resolves)

  • Use corticosteroids (prednisone 30-50mg taper over 7-10 days) if NSAIDs/colchicine contraindicated

  • Contact rheumatology for potential intraarticular steroid injection

  • Emerging evidence that irate lowering therapy may have a role during acute gout flare (if patient meets indications)

• Long term managment:

  • Urate lowering therapy (if indicated)

  • For comorbid HTN, avoid hydrochlorothiazide, use losartan (has an independent effect to lower uric acid)

  • Gout friendly diet (see graphic)