An elderly woman with two recent episodes of acute arthritis

The differential diagnoses in an elderly female patient with acute transient monoarthritis include crystal-associated arthritis, palindromic rheumatism and septic arthritis.

Case scenario

Helen is a slim and active 72-year-old woman who is usually well. She has presented after two episodes of acute arthritis in the previous fortnight. The first episode involved her right wrist, lasted 48 hours and completely resolved. The second episode developed a week later in her left elbow, which also became hot and swollen and extremely painful to move but similarly had totally resolved after 48 hours. She remembers that she had been treated for about five years more than 20 years previously for an arthritis that was thought to be either lupus or rheumatoid. She has experienced absolutely no symptoms in the intervening years and had almost completely forgotten about the whole episode.