Unilateral knee effusion in an elderly patient: an unusual presentation of rheumatoid arthritis
Morteza Khodaee 1 3 , Lindsay Ogle 2 , Cleveland Piggott 11 University of Colorado School of Medicine, Department of Family Medicine & Orthopedics, Division of Sports Medicine, AF Williams Clinic, Denver, Colorado, USA
2 University of Colorado School of Medicine, Swedish Family Medicine Residency, Aurora, Colorado, USA
3 Corresponding author. Email: Morteza.khodaee@cuanschutz.edu
Journal of Primary Health Care 12(4) 391-394 https://doi.org/10.1071/HC20035
Published: 16 September 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
Unilateral atraumatic knee effusion is a relatively common presenting complaint among geriatric patients in primary care and musculoskeletal speciality clinics. Gout, pseudogout, degenerative joint diseases and reactive arthritis are the most common causes of the atraumatic knee effusions. Rheumatoid arthritis very rarely presents as arthritis of one or two large joints. Arthrocentesis, plain radiography and screening blood tests should be performed to help narrow the differential diagnosis. In some cases, advanced imaging modalities such as MRI may be indicated. This study reports a case of rheumatoid arthritis in a 75-year-old gentleman with oligoarthropathy of two large joints as the presenting symptoms.
KEYwords: Synovitis; rheumatoid arthritis; arthrocentesis; oligoarthropathy
References
[1] Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: a review. JAMA. 2018; 320 1360–72.| Diagnosis and management of rheumatoid arthritis: a review.Crossref | GoogleScholarGoogle Scholar | 30285183PubMed |
[2] Allen A, Carville S, McKenna F, Guideline Development Group Diagnosis and management of rheumatoid arthritis in adults: summary of updated NICE guidance. BMJ. 2018; 362 k3015
| Diagnosis and management of rheumatoid arthritis in adults: summary of updated NICE guidance.Crossref | GoogleScholarGoogle Scholar | 30076129PubMed |
[3] Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62 2569–81.
| 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Crossref | GoogleScholarGoogle Scholar | 20872595PubMed |
[4] Kvien TK, Uhlig T, Odegard S, Heiberg MS. Epidemiological aspects of rheumatoid arthritis: the sex ratio. Ann N Y Acad Sci. 2006; 1069 212–22.
| Epidemiological aspects of rheumatoid arthritis: the sex ratio.Crossref | GoogleScholarGoogle Scholar | 16855148PubMed |
[5] Devaraj NK. The atypical presentation of rheumatoid arthritis in an elderly woman: a case report. Ethiop J Health Sci. 2019; 29 957–8.
| 30700964PubMed |
[6] Sarazin J, Schiopu E, Namas R. Case series: monoarticular rheumatoid arthritis. Eur J Rheumatol. 2017; 4 264–7.
| Case series: monoarticular rheumatoid arthritis.Crossref | GoogleScholarGoogle Scholar | 29308281PubMed |
[7] Weissman S, Alsheikh M, Kamar K, et al. Non-insidious large joint manifestation of severe cachectic rheumatoid arthritis. Cureus. 2018; 10 e3266
| Non-insidious large joint manifestation of severe cachectic rheumatoid arthritis.Crossref | GoogleScholarGoogle Scholar | 30656082PubMed |
