EpistemisMigratory joint swelling
Specialty: Musculoskeletal.
Why it occurs
- Acute rheumatic fever (previous pharyngeal infection by Streptococcus pyogenes)
- Disseminated gonococcemia (infection with Neisseria gonorrhoeae, presenting with tenosynovitis and migratory arthritis in young adults)
- Lyme arthritis in early disseminated phase (Borrelia burgdorferi)
- Subacute bacterial endocarditis
- Systemic lupus erythematosus or mixed connective tissue disease
- Whipple's disease (Tropheryma whipplei infection)
Initial workup
Transthoracic and transesophageal echocardiogram | Serial blood cultures (minimum 3 series) | Cultures of urethral, cervical, pharyngeal and synovial fluid exudate | Antistreptolysin O (ASLO) titers | Serology for Lyme and antinuclear antibodies (ANA).
red flags
Joint swelling that migrates from one large joint to another, associated with chest pain (pericarditis), new-onset heart murmur, respiratory difficulty, or characteristic skin rash with raised edges (Erythema marginatum) or distal hemorrhagic pustules (gonococcemia or acute rheumatic fever).
Standard management
- Penicillin G benzathine — 1.2 million intramuscular IU in a single dose for streptococcal eradication in rheumatic fever
- Ceftriaxone — 1-2 g IV every 24 hours for disseminated gonococcal arthritis
- Acetylsalicylic acid — aspirin, 1 g every 6 hours orally; anti-inflammatory of choice for the management of migratory arthritis in acute rheumatic fever
- Doxycycline (100 mg every 12 hours orally for 21 days in case of confirmed suspicion of Lyme disease).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4