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What is Monoarticular Rheumatoid Arthritis?
Rheumatoid arthritis is a joint inflammatory disorder that is often chronic, painful, and debilitating. In many cases, rheumatoid arthritis strikes multiple joints in the same individual. However, when it affects only a single joint, it is specifically referred to as monoarticular rheumatoid arthritis (MRA). The most common causes of MRA are excessive build up of calcium crystals in or near the affected joint (a condition which is known as gout), trauma (such as that caused by severe injury), and bacterial infection. In many cases, MRA is the first of multiple arthritis disorders to appear in an individual. For this reason, MRA always requires immediate medical treatment that is not only specifically aimed at overcoming MRA symptoms, but is also designed to prevent the manifestation of additional forms of arthritis. Further, if left untreated, MRA can quickly cause the irreversible destruction of cartilage in the joint region.
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How is MRA Diagnosed?
There are many diagnostic approaches that are available to the clinician in diagnosing a patient as having or not having MRA. The first step that the clinician usually takes is to obtain the complete medical and family medical history of the patient being diagnosed to determine whether other, non-arthritic conditions potentially may be the cause of the patient's symptoms. At this time, the medical professional will attempt to rule out soft tissue problems, in particular, as the source of the patient's joint pain and stiffness.
If, after taking these steps, the clinician has not ruled out MRA as the causative condition, radiographs (such as by CAT scan or MRI) that image the problem joint and blood tests that measure white blood cell count and uric acid concentration (both of which are indicative of MRA) may be performed.
Once a patient has been positively diagnosed as having MRA, treatment options are immediately assessed and decided upon. Again, time is of the essence when it comes to preventing the possible long-term negative effects that monoarticular rheumatoid arthritis can cause.
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How is Monoarticular Rheumatoid Arthritis Treated?
The options for treating MRA generally fall into three categories: drugs, therapy, and surgery. Common drugs that are used to treat MRA include nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, Motrin, and stronger NSAIDs that are available only by prescription. Other drugs of choice are steroids, such as prednisone and methylprednisone, which both alleviate joint pain and retard the rate of joint damage. In some cases, immunosuppressants (which act to hinder the body's immune response) and TNF-alpha inhibitors (which are "good" proteins that are designed to negate the function of other harmful proteins) are used.
Therapy options include participation in regular exercise regimens, the use of canes or other walking-assistive devices, and the use mechanical gripping tools that are specifically designed to grasp objects. Unfortunately, most therapy options only aid in keeping symptoms at bay or are aimed at coping with symptoms and are not sufficient for permanently ridding symptoms from the patient.
If MRA cannot be alleviated through drug or therapy means, surgery may be elected as a final option. Types of surgery that may be performed include total joint replacement (wherein the natural joint is replaced with an artificial joint), joint fusion (wherein the affected joint is fused to a nearby portion of the body in an effort to stabilize the joint and negate its wear of other parts of the body), and removal of the affected joint's synovial lining, if that lining is in fact the root cause of the symptoms.
This article is only meant to provide some basic background information regarding the common joint inflammatory condition known as monoarticular rheumatoid arthritis. It is not meant to replace the good advice of your doctor.
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D.G. Baker and H.R. Schumacher, Jr., Acute Monoarthritis, New England Journal of Medicine 329:1013-1020 (1993).
E.G.L. Bywaters and B.M. Ansell, Monoarticular Arthritis In Children, Annals of the Rheumatoid Diseases 24:116-124 (1965). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010386/pdf/annrheumd00217-0015.pdf
Mayo Clinic, Rheumatoid arthritis: http://www.mayoclinic.com/health/arthritis/DS01122
Mayo Medical Laboratories, Diagnosis of Crystalline and Septic Arthritis: http://www.mayomedicallaboratories.com/media/articles/communique/apr2001.pdf
S. Chokkalingham et al., Diagnosing Acute Monoarthritis in Adults: A Practical Approach for the Family Physician, American Family Physician 68:83-09 (2003). http://www.aafp.org/afp/2003/0701/p83.html