Chapter 17 Acute joint pain
Case 17.1
Dale, a 43-year-old male, presents with a 3-week history of fatigue and an intermittent, low grade temperature which is accompanied by chills, diffuse myalgias, arthralgia, headaches and a rash. He noted that the rash started on his right inner thigh and was initially 2–2.5 cm and bright red with an even distribution. This lasted for about a week, expanded to about a 10 cm diameter, and ultimately faded with the red colour remaining only at the border. Dale takes no medications, and had no known drug allergies. His family history was non-contributory. He denies tobacco and illicit drug use, and states that he uses alcohol in moderation. Dale has no pets, had not recently changed detergents or purchased new clothing. Before the appearance of the rash he was on a corporate paintball event in the Hamptons. The rash was noticed 5 days after the paintball event and progressed over the 3 weeks, to the extent where he sought medical intervention.
Case 17.2
History
John is a 52-year-old male builder who presents with a painful and swollen left knee. It commenced yesterday for no apparent reason, and progressively worsened over an 8-hour period. Today the pain has eased a little. He denies any recent trauma to the knee or any previous similar episodes in his knee or any other joints, and has no significant past medical history. His medical practitioner recently sent him for blood tests to rule out diabetes and thyroid problems due to his recent weight gain, and the results of these tests were normal. He denies any fever, malaise, night sweats or any recent loss of weight or appetite, does not take any medications and denies using any illicit drug use. John drinks a couple of large glasses of whisky most nights at home and is a non-smoker. He has not travelled abroad in the past 12 months. He is happily married and enjoys walking his dogs in the New Forest (Hampshire, UK) at the weekends. He has not noticed any tick bites or unusual rashes. There is no known family history of arthridities.
Physical examination
| Vitals | •Pulse rate/min | 65, regular |
| •Respiratory rate/min | 16 | |
| •Blood pressure mm Hg | 145/95 | |
| •Height (cm) | 173 | |
| •Weight (kg) | 95 | |
| •BMI | 32 | |
| •Temperature (degrees C) | 38 | |
| HEENT | Unremarkable | |
| Chest | No cardiomegaly, no murmurs, chest clear | |
| Abdomen | Soft, non-tender, no masses | |
| Limbs | Examination of the left knee revealed erythema, tenderness, swelling, some heat but no palpable bony enlargement. Both active and passive range of motion (ROM) of the knee were painful and limited, but with no crepitus. No rash, puncture wound or abrasions were noted around the knee. No other joints seem to be involved, and there was no evidence of tophi | |
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