0720 - Acute Arthritis

Question 1

What is the Difference between Arthralgia and arthritis?

Answer 1

Arthralgia - subjective joint pain +/- tenderness

Arthritis - objective with inflammation, swelling, heat, redness.

Question 2

What is the golden rule of treating a red, swollen, inflamed, acutely arthritic joint?

Answer 2

It is infective until proven otherwise.

Question 3

How does acute arthritis present?

Answer 3

Often within hours of onset.
Usually infective or inflammatory - need to exclude infection
Can be mono, poly, or oligoarthritis if gout or CPPD
Can be haemarthrosis.

Question 4

How does infective arthritis present?

Answer 4

Infants present with global sepsis, toddlers as limp

Adults have warm, swollen, red, painful joint. Gradual onset of constant pain and disturbed sleep.

Question 5

What are the key aspects of an arthritis history?

Answer 5

Timing - onset (acute, sub-acute, chronic) and duration
Inflammatory or non-inflammatory - early morning stiffness? Improve with activity?
Pattern - Mono, oligo, poly +/- axial involvement. Symmetrical?
Accompanying features? Systemic (fever, night-sweats, weight loss, fatigue), extra-articular features, serology (SCP, ESR, biochemistry).

Question 6

What is Reactive arthritis?

Answer 6

Follows gastro or UTI. Subacute oligoarticular lower limb (asymmetrical).
Swollen joint, effusive, puffy, not red, painful but not intolerable (low-level inflammation).

Question 7

What are the 2 most common causes of Polyarthritis

Answer 7

Rheumatoid arthritis (may be RF negative initially)
SLE (Female of Childbearing Age, rash common, ANA always, anti-dsDNA is helpful)