27. Acute Joint Pain Flashcards
What diagnosis must you exclude in a patient with acute joint pain?
Septic arthritis
What are the articular causes of single acutely painful joints in adults?
Trauma, gout, pseudogout and septic arthritis
What are the peri-articular causes of single acutely painful joints in adults?
ligament injury, tendinitis, bursitis, fascitis, epicondylitis
What are the non-articular causes of single acutely painful joints in adults?
Nerve entrapment, radiculopathy
Acute joint pain- pain that is worse on movement is likely to be…
Non inflammatory
Acute joint pain- rapid onset likely to be…
septic arthritis, gout, pseudogout and trauma
Joint pain- insidious onset likely to be…
bursitis, tendonitischronic onset- osteoarthritis
What are common risk factors for gout?
thiazide diuretics, recent heavy alcohol intake, chronic renal failure and chemotherapy, history of real stones, gout in the past
What are common risk factors for septic arthritis?
Immunosuppressants and prosthetic joints
What are risk factors for haemarthrosis?
Coagulopathies, anticoagulant use, trauma
Acute joint pain- what do you need to ask about in PMHx?
Recent GI or urethral infection, take a sexual history as gonoccal infection can be asymptomatic and lead to septic arthritis
Have they had any previous episodes
Have they had any rheumatological conditions
Why is the pattern of joint involvement important in acute joint pain?
Involvement of joints sequentially= gonococcus and rheumatic fever
Several joints simultaneously= chronic polyarthritis
What should you look out for on joint examination?
Look, feel, move
Look- erythema, scars, swelling, muscle wasting, bony deformities, asymmetry
Feel- effusions, tenderness on bones, ligaments, tendons along joint line
Move- test full range of movement at the joint, passive and active
What are articular conditions more likely to present with?
Diffusely inflamed joint, pain on passive and active motion
What are peri-articular conditions more likely to present with?
Focal point of tenderness on palpation, pain worse on active instead of passive movement
What should be examined beyond joints?
Skin for tophi and rheumatoid nodules, rashes
Nail- pitting, subungual hyperkeratosis, onycholysis (signs of psoriasis)
Uveitis- inflammation of middle layer of eye
Mouth ulcers- possible crohn’s
Lung fibrosis
Describe the possible results of arthrocentesis
Crystals may be present in gout Infection- cloudy aspirate Blood- haemarthrosis seen in trauma Fat globules- fracture White cells- inflammation
What are second line investigtions after arthrocentesis for acute joint pain?
cultures, FBC, CRP, ESR, PTLook for rheum antibodies
Serum urate
Plain radiographs
MRI- soft tissue injury
What is acute management of gout?
Colchinine (contra indicated in patients with renal or hepatic impairment)
NSAIDs
Corticosteroid injections
What is the chronic management of gout?
Decrease urate production- allopurinol and febuxostat
Increase urate excretion: sulfinpyrazone and probenecid
Increase degradation of urate: rasburicase (not nice approved, high cost)
