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01a: Acute Arthritis Flashcards

1
Q

How is acute defined for acute arthritis?

A

Less than 6 weeks duration

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2
Q

What is arthritis?

A

Inflammation localized to articular structures; accompanied by swelling (synovitis and/or effusion), warmth, discomfort and redness.

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3
Q

What is arthralgia?

A

Subjective term of non-inflammatory joint pain

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4
Q

What does rapid onset suggest?

A

Traumatic, septic or crystalline etiology

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5
Q

What does slow/insidious onset suggest?

A

Systemic rheumatic disease or non-inflammatory process (such as osteoarthritis)

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6
Q

What do worse-in-the-morning symptoms suggest?

A

Systemic rheumatic disease (improves with mobility)

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7
Q

What do worse-at-night symptoms suggest?

A

Sprain/strain/non-inflammatory process

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8
Q

What do worse-with-activity symptoms suggest?

A

Tendinitis/bursitis/non-inflammatory process

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9
Q

What do worse-with-rest symptoms suggest?

A

Systemic rheumatic disease

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10
Q

What does joint localization suggest?

A

Arthritis or arthralgia

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11
Q

What does inter-articular localization suggest?

A

Diffuse pain syndromes (e.g., fibromyalgia)

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12
Q

What condition is uncommon with polyarticular symptoms?

A

Septic arthritis

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13
Q

Can monoarticular symptoms be present with systemic rheumatic disease?

A

Yes; may be an early presentation

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14
Q

What rheumatic condition is often preceded by trauma?

A

Calcium pyrophosphate deposition disease (CPPD); AKA pseudogout

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15
Q

What do hot-to-touch joints suggest?

A

Septic or crystalline etiology

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16
Q

What do cool-to-touch joints suggest?

A

Non-inflammatory etiology

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17
Q

What is”touch-me-not” pain, and what does it suggest?

A

Painful for even bedsheets/clothes to touch; seen in septic or crystalline arthritis

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18
Q

In what disease is stiffness > pain?

A

Systemic rheumatic disease

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19
Q

What diseases present with vague, deep aches?

A

Hyperparathyroidism, osteomalacia, bone lesions (night pain)

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20
Q

What diseases present with burning/numbness/tingling?

A

Neurogenic

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21
Q

What diseases present with claudication?

A

Vascular and spinal stenosis

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22
Q

What disease often presents with symmetry?

A

Systemic rheumatic diseases

23
Q

What diseases often present with constitutional/prodromal symptoms (e.g., fever, malaise, flu-like symptoms)?

A

Infection, systemic rheumatic diseases, occasionally crystalline arthritis

24
Q

What does intercritical return to complete normalcy suggest?

A

Crystalline arthritis

25
What are specific indicators of systemic rheumatic diseases?
* Cutaneous manifestations (psoriasis, photosensitivity, purpura, skin thickening, erythema nodosum, nodules) * Swollen glands * Raynaud's (excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas) * Oral/nasal ulcers * Pleurisy/pericarditis * Eye inflammation * Nail changes * Dry eyes/mouth * Proximal muscle weakness * Sinusitis * Hearing loss
26
What are the following findings in **tendinitis/bursitis**? 1. Symmetry 2. Inflammation 3. Tenderness 4. Instability 5. Locking 6. Multi-system disease
1. Uncommon 2. Over tendon/bursa 3. Focal 4. Uncommon 5. Unusual except with tears 6. No
27
What are the following findings in **non-inflammatory **joint disease? 1. Symmetry 2. Inflammation 3. Tenderness 4. Instability 5. Locking 6. Multi-system disease
1. Occasional 2. Unusual 3. Unusual (variable) 4. Occasional 5. Possible (implies loose body/internal derangement) 6. No
28
What are the following findings in **systemic rheumatic disease**? 1. Symmetry 2. Inflammation 3. Tenderness 4. Instability 5. Locking 6. Multi-system disease
1. Common 2. Common 3. Over entire joint space 4. Uncommon 5. Uncommon 6. Often
29
What are the common etiologies of **acute monoarthritis**?
* Infection * Bacterial (gonococcal vs. non-gonococcal) * Viruses (although often polyarticular) * Fungi/spirochetes/mycobacteria * Crystal-induced (gout, pseudogout [CPPD]) * Trauma * Hemarthrosis * Osteonecrosis * Early monoarticular presentation of polyarticular disease
30
What synovial fluid findings suggest monoarthritis?
1. Cell count + differential w/ WBC \>2K or \>75%PMN (suggests inflammatory etiology) 2. Gram stain (+) culture (negative studies do not r/o septic joint) 3. Crystal assessment using **polarized light microscopy**
31
What is the differential for non-inflammatory joint fluid (\<2K WBC/uL)?
* Osteoarthritis * Trauma * Charcot's joint * Pancreatitis * Hemochromatosis * Acromegaly * Glucocorticoid withdrawal * Hypertrophic osteoarthropathy * Avascular necrosis * Pigmented villonodular synovitis * Systemic lupus erythematous
32
What is the differential for inflammatory joint fluid (\>2K WBC/uL)?
* Rheumatoid arthritis * Psoriatic arthritis * Spondyloarthropathies * Juvenile chronic arthritis * Gout * Pseudogout * Systemic lupus erythematous * Septic arthritis
33
When is it appropriate to get a CT or MRI for joint pain?
Suspected osteomyelitis as focus, or soft-tissue abscess
34
Bacterial septic arthritis
* Sepsis, extensive joint damage, mortality * Mortality ~10% overall; 19-33% in elderly or with comorbidities * 40% with permanent loss of joint function * Broken down into gonococcal or non-gonococcal
35
Gonococcal septic arthritis
* Epidemiology: * Incidence ↓ over past 2 decades * Seen in sexually active YAs * F \> M * Other clinical features * Polyarthralgia can precede (but mono in 50%) * Constitutional sx * Tenosynovitis, especially wrist (68%) * Skin lesions (75%): erythematous papules progress to vesicles or pustules on extremities and trunk * Anogenital infx often asx!
36
Non-gonococcal septic arthritis
* Etiology: * Gram (+) in 80% of cases * *S Aureus* in 60% of non-G cases * Gram (-) in 10-20% of cases * *_E. Coli_*, *Proteus, Klebsiella, Enterobacter* * Seen in v. young, elderly, injection drug use, immunocomp'd * Diabetes is a risk factor * Presentation: * Prodrome of malaise & fever (often mild) * Large joint preference (knees/hips \> shoulders \> wrist/ankles) * Management: * Aggressive * Serial aspiration to dryness vs. open surgical drainage w/ lavage * Parenteral abx * Splinting & physical therapy to prevent contractures and muscle atrophy
37
What is a **contracture**?
Condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.
38
Crystal arthritis types
Gout vs. calcium pyrophosphate deposition (CPPD)
39
Gout
* Intense articular inflammation * "Touch-me-not" tenderness * Minimal to no prodrome * Joint predilection: 1st metatarsophalangeal, midfood, ankle, knee, wrist, elbow, distal interphalangeal
40
Calcium pyrophosphate deposition (CPPD)
* Mono-, oligo-, or polyarticular * Knee most commonly affected, followed by wrist (MTP uncommon) * Preceding minor joint trauma often reported * Associated w/ hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia
41
What is joint effusion?
Presence of increased intra-articular fluid
42
Lyme Arthritis
Features dependent on phase of disease * Early disseminated: * Poly-arthr**_algia_** * ELISA may be negative early (but occurs prior to development of bullseye rash) * Late: * Weeks - months after primary infx * Positive ELISA * Mono, oligo, occasionally poly**_arthritis_** * Asymmetric * Large/medium joints * Large effusion in single knee in most
43
Polyarthritis differential
* Infection * Gonococcal * Meningococcal * Lyme disease * Rheumatic fever * Bacterial endocarditis * Viral (rubella, parvovirus, HBV, HCV) * Fungal (histoplasmosis, diseminated coccidiodomycosis) * Mycobacterial * Systemic rheumatic * RA * SLE * Sjogren's syndrome * Reactive arthritis * Psoriatic arthritis * Polyarticular gout * Sarcoid arthritis * Vasculitis * Polymyalgia rheumatica * Inflammatory neuropathies
44
What polyarthritic diseases progress in a migratory pattern?
* Rheumatic fever * Gonococcal (disseminated gonococcemia) * Early phase of Lyme disease
45
What polyarthritic diseases progress in an additive pattern?
* RA * SLE * Psoriasis
46
What polyarthritic diseases occur in an intermittent pattern?
* Gout * Reactive arthritis
47
Viral arthitis
* Patho: direct invasion of synovium by virus --\> immune complex mediated synovitis --\> virus acts as antigenic target for immune system * Tx: Usually self-limited; requires no specific therapy
48
Most common virus causing chronic polyarthralgia/itis?
HCV
49
Common viruses causing self-limited polyarthralgia/itis?
* HBV * Parvovirus * Alphavirus * Dengue (uncommon, but causes v. intense sx)
50
Viruses less likely to cause polyarthralgia/itis?
* EBV * CMV * Mumps * Coxsackie * HSV * Adenovirus
51
Emerging cause of chronic viral polyarthritis (especially in WaHi)?
Chikungunya (immigration from DR)
52
What common symptoms are seen in chikungunya infection?
* Days to weeks: "saddle back fever" * Fever * H/A * Weeks * Fatigue * Myalgias * Weeks to months * Arthralgia/arthritis * Rash * Insomnia
53
What symptoms of chikungunya infection are sometimes seen in children (but rare in adults)?
* Photophobia * Retro-orbital pain * Vomiting/diarrhea * Acute encephalopathy * Acute meningitis

RMSK (16 decks)

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