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YR3: MM FC Ed. > 27. Acute Joint Pain > Flashcards

27. Acute Joint Pain Flashcards

1
Q

What diagnosis must you exclude in a patient with acute joint pain?

A

Septic arthritis

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2
Q

What are 4 articular causes of single acutely painful joints in adults?

A

Trauma
Gout
Pseudogout
Septic arthritis

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3
Q

What are 5 peri-articular causes of single acutely painful joints in adults?

A 
Ligament injury
Tendinitis
Bursitis
Fascitis
Epicondylitis
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4
Q

What are 2 non-articular causes of single acutely painful joints in adults?

A

Nerve entrapment

Radiculopathy

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5
Q

Pain that is worse on movement and improves with rest is likely to be…

A

Non inflammatory

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6
Q

Acute joint pain- list 4 causes with rapid onset

A

Septic arthritis
Gout
Pseudogout
Trauma

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7
Q

Joint pain- list 2 causes with insidious onset

A

Bursitis

Tendonitis

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8
Q

What are 6 common risk factors for gout?

A 
Thiazide diuretics
Recent heavy alcohol intake
Chronic renal failure
Chemotherapy
Hx renal stones
Hx gout
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9
Q

What are 2 common risk factors for septic arthritis?

A

Immunosuppression (diabetes, HIV, steroids)

Prosthetic joints

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10
Q

What are 3 risk factors for haemarthrosis?

A

Coagulopathies (haemophilia)
Anticoagulant use (warfarin)
Trauma

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11
Q

Acute joint pain- what do you need to ask about in PMHx?

A

Recent GI or urethral infection: take a sexual hx as gonoccal infection can be asymptomatic + lead to septic arthritis
Previous episodes? (recurrent conditions- crystal arthropathies + overuse)
Rheumatological conditions?

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12
Q

Why is the pattern of joint involvement important in acute joint pain?

A

Involvement of joints sequentially= gonococcus + rheumatic fever
Several joints simultaneously= chronic polyarthritis

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13
Q

What should you do on joint examination?

A

Look, feel, move
Look: erythema, scars, swelling, muscle wasting, bony deformities, asymmetry
Feel: effusions, tenderness on bones, ligaments, tendons along joint line, temperature + neurovascular status
Move: test full range of passive + active movement

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14
Q

What are articular conditions more likely to present with?

A

Diffusely inflamed joint (red, hot, painful)

Pain on passive + active motion

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15
Q

What are peri-articular conditions more likely to present with?

A

Focal point of tenderness on palpation

Pain worse on active instead of passive movement

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16
Q

What should be examined beyond joints?

A

Skin: Tophi, 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 (associated with inflammatory arthropathies e.g. RA)

17
Q

Describe the possible results of arthrocentesis

A 
Crystals may be present in gout
Infection: cloudy aspirate
Blood: haemarthrosis seen in trauma
Fat globules: fracture
White cells: inflammation
18
Q

What are second line investigtions after arthrocentesis for acute joint pain?

A 
Cultures 
FBC
CRP
ESR
PT for coagulopathy in haemarthrosis
RA?: Rheumatoid factor, anti-CCP + ANA
Serum urate (though often L/N in acute gout)
Plain radiographs
MRI: soft tissue injury
19
Q

What is acute management of gout?

A

Colchinine (contra indicated in patients with renal or hepatic impairment)
NSAIDs
Corticosteroid injections

20
Q

What is the chronic management of gout?

A

Decrease urate production: allopurinol + febuxostat
Increase urate excretion: sulfinpyrazone + probenecid
Increase degradation of urate: rasburicase

21
Q

Joint pain- what may present with chronic onset?

A

Osteoarthritis

22
Q

Give 3 drugs that can predispose to gout?

A

Thiazides
Low-dose aspirin
Ciclosporin

23
Q

What class of drugs can predispose to osteoporosis?

A

Steroids

24
Q

How do the crystals differ in gout and pseudogout?

A

G: Urate: Negatively bi-refringent + needle shaped
P: Calcium pyrophosphate: Positively bi-refringent + rhomboid

25
Q

Why must colchicine always be prescribed with allopurinol in the first 6 weeks?

A

Initial doses of allopurinol can paradoxically result in acute gout

26
Q

Describe the management of septic arthritis

A

Analgesia
Take blood cultures
Give broad spectrum Abx
Joint aspiration + lavage

27
Q

What is the most likely infective organism in a native joint?

A

Staphylococcus aureus

28
Q

What is the most likely infective organism in a prosthetic joint?

A

Staphylococcus epidermis

29
Q

Give 4 features of osteoarthritis on a plain radiograph

A

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts

YR3: MM FC Ed. (46 decks)

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