How do you approach evaluation and management of a patient with recurrent monoarticular inflammatory arthritis of unclear etiology?
Synovial fluid analysis: cell count >100,000, > 80% neutrophils. Gram stain, cultures (including fungal and mycobacterial), synovial biopsy, and crystal analysis are negative. Was treated with IV antibiotics without any improvement.
2 Answers
Mednet MemberInvited Expert
Rheumatology · Berkshire Health Systems
Answered on
Routine testing will not identify Lyme disease although the WBC count is higher than usual. If the antibiotic does not target B burgdorferi recurrence might mean inappropriate therapy previously.
WBC count WAAAY too high for mere trauma or internal derangement.
Anything else to suggest psoriasis? Lo...
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Mednet MemberInvited Expert
Rheumatology · Uniformed Services University of the Health Sciences (USUHS)
Answered on · Updated on
To add to Dr. @Dr. First Last's excellent response (and on the lines of thinking about PsA), reactive arthritis can notoriously cause a "pseudoseptic" joint, especially of the knee. I'd revisit a history of possible infections (GI/genitourinary), inflammatory lower back pain, reexamine the conjuncti...
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