Sharmin, Jack, and Youssef discuss their approach to joint pain, exploring a case study of a 32-year-old male with left knee and ankle pain. They differentiate between septic arthritis, gout, reactive arthritis, and rheumatoid arthritis based on symptoms. The discussion emphasizes the diagnostic challenges in managing cases of clinical uncertainty and the importance of considering various diagnostic inputs.
A 32-year-old man presents with left knee and ankle pain and swelling following burning urination and urethral discharge. The pain worsened over four days, prompting his ER visit. The sequential joint involvement includes the knee and ankle, leading to considerations of monoarticular arthritis for diagnosis.
Analyzing Arthritis Differential Diagnosis
Joint pain localization defines the diagnostic approach, noting two involved joints. Diagnostic focus shifts to monoarticular arthritis, considering septic arthritis, crystalline diseases like gout or pseudogout, and autoimmune diseases such as reactive or rheumatoid arthritis. Clinical details, including recent purulent urethral discharge, highlight the need to evaluate for disseminated gonococcal infection.
Laboratory and Synovial Fluid Analysis
Laboratory results reveal an elevated CRP and synovial fluid analysis indicating inflammatory arthritis. A synovial white blood cell count of 21,000 with neutrophils raises concern for septic arthritis. Negative synovial and gonorrhea nucleic acid tests guide diagnostic considerations towards reactive arthritis.
Diagnostic Approach and Treatment Plan
The collaborative diagnostic approach considers reactive arthritis as the likely diagnosis, supported by negative culture results and a positive urine chlamydia test. Treatment involves NSAIDs and doxycycline, leading to the patient's full resolution of symptoms during follow-up, validating the strategy employed.