Single Joint Pain (Monarthropathy): Or something else? Differential Diagnosis

Blood, blood-forming organs-immune system (D50-D90).

  • Hemophilia (hemophilia).
  • Sarcoidosis (synonyms: Boeck’s disease; Schaumann-Besnier’s disease) – systemic disease of connective tissue with granuloma formation.
  • Bleeding tendency due to factor deficiency, unspecified.
  • Willebrand-Jürgens syndrome (synonyms: von Willebrand-Jürgens syndrome; von Willebrand syndrome, vWS) – most common congenital disease with increased bleeding tendency; disease is predominantly transmitted autosomal-dominantly with variable penetrance, type 2 C and type 3 are inherited autosomal-recessively; there is a quantitative or qualitative defect of the von Willebrand factor; this impairs, among others. Among other things, the platelet aggregation (aggregation of platelets) and their cross-linking and / or (depending on the manifestation of the disease) the degradation of coagulation factor VIII is insufficiently inhibited.

Infectious and parasitic diseases (A00-B99).

  • Gonorrhea (gonorrhea) – sexually transmitted infectious disease that particularly affects the synovium in joints. Prevalence: 1-2% of the population; most commonly women.

Musculoskeletal system and connective tissue (M00-M99).

  • Acute arthritis or acute septic arthritis – joint inflammation caused by pathogens such as bacteria (bacterial arthritis); commonly seen in the knee jointRisk factors for septic arthritis include advanced age (> 80 years), joint punctures, prosthesis in the hip or knee joint, joint surgery, rheumatoid arthritis, diabetes mellitus, and skin infections
  • Arthritis psoriatrica – joint involvement in the context of psoriasis.
  • Osteoarthritis – gonarthrosis (knee osteoarthritis), coxarthrosis (hip osteoarthritis); typically older persons are affected
  • Chondrocalcinosis (synonym: pseudogout); gout-like disease of the joints caused by deposition of calcium pyrophosphate in cartilage and other tissues; leads, among other things, to joint degeneration (often of the knee joint); symptomatology resembles an acute gout attack
  • Gout / hyperuricemia (increase in uric acid levels in the blood) – podagra (severe joint pain in the metatarsophalangeal joint of the big toe) or affection of a peripheral joint (metatarsophalangeal joint of the thumb; this form of gout is also called chiragra); other joints frequently affected are the knee and ankle joints
  • Gonalgia (knee pain) – see below Gonalgia; note: knee pain as transmitted pain in children.
  • Calcifying periarthritis – inflammation of the tissue surrounding the joint.
  • Osteochondrosis dissecans – disease more common in adolescents, leading to circumscribed aseptic bone necrosis (“death of bone”) below the articular cartilage, which may end with the rejection of the affected bone area with the overlying cartilage as a free joint body (joint mouse); this often causes irritation.
  • Osteomyelitis (bone marrow inflammation); not uncommon in children; in adults secondary after fractures or surgery on the bone/joint.
  • Patellofemoral pain or patellar syndrome (synonyms: peripatellar pain syndrome, chondropathia patellae; PFPS = patellofemoral pain syndrome); load-dependent complaint syndrome in the patella area, which occurs in adolescents and disappears after completion of puberty.
  • Peripheral spondyloarthritides (SpA; pSpA):
    • Joint involvement in the form of mono-/oligoarthritis (inflammation of one joint/occurrence of arthritis in fewer than 5 joints), asymmetric, lower extremities affected
    • Enthesitis (inflammation in the area of bony insertion sites of ligaments and tendons and joint capsules) and/or dactylitis (inflammation of the fingers)
    • Axial involvement
    • HLA-B27, Crohn’s disease (inflammatory bowel disease (IBD)), psoriasis (psoriasis), previous infection.
  • Pyogenic arthritis – rare, autoinflammatory disease of childhood, mainly affecting the joints and skin.
  • Reactive arthritis (synonym: postinfectious arthritis / joint inflammation) – secondary disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
  • Rheumatoid arthritis, atypical course (symptoms: symmetrical affection of the small joints; morning stiffness).
  • Psoriatic arthritis (arthritis based on psoriasis) (symptoms: psoriatic skin lesions).

Neoplasms – tumor diseases (C00-D48).

  • Tumors, unspecified; most commonly affecting adolescents.

Further

  • Joint trauma (joint injury: e.g., hemarthrosis (disease of a joint due to repeated and persistent hemorrhage), hydrops (fluid inside a joint); see history below).