4.1 Management of acute arthritis Flashcards
What are mono, oligo and polyarthritis?
Mono = 1
Oligo = 2-4
Poly > 4
What do you need to do with presentation of acute swelling?
Exclude infection
How do infants and toddlers present with acute monoarthritis?
Infants - global sepsis (fever, unwell, dehydrated)
Toddlers with a limp
How do adults present with acute monoarthritis?
warm, swollen, red, painful joint, gradual onset, pain is constant, disturbs sleep, poor function
What are the most common causes of acute infective monoarthritis and what do you need to look for?
Bacterial - staph aureus, streptococci, resistant organisms
Source of entry of the organism
Who most commonly gets acute infective arthritis?
immunocompromised, diabetics, steroid use
What is the common community presentation of gout?
Fat, forty, male, wakes up with severe pain in big toe
What is the hospital presentation of gout?
Older, either sex, recent trauma, surgery etc. On diuretics, mild CRF, no FH or previous attacks
What are the investigations for acute monoarthritis?
Examination (TEMP)
Blood culture, ESR, CRP
Aspiration: ED or US, WCC, crystals, culture,
CXR
What should you do if you expect infective monoarthritis?
Start on broad spectrum antibiotics, joint lavage and maybe biopsy
What are the two common causes of subacute (days) monoarthritis? and what are the less common causes?
Gout and calcium phosphate deposition disease (pseudo-gout)
Infection, SBE and reactive arthritis, rheumatic fever
What is reactive arthritis, what is the presentation and what are the common causes?
Immune condition that results from an infection in another part of the body
Effusion, boggy synovitis, not red, mild tender, painful but tolerable
Shigella, salmonella, yersinia, campylobacter or chlamydia
Usually follows bowel or genito-urinary infection
What are the common causes of acute (
Viral, crystal arthritis, RA, SLE
What are the common causes of polyarthritis > 6 weeks
RA
OA, PsA, vasculitis, CTD related, SLE
What are the viral causes of arthritis?
Parvovirus B19, Rubella and vaccine, Ross river and Barmah forrest, Chikungunya, Hep B and Hep C, Mumps, adenovirus
What is the typical presentation of viral arthritis?
Very disabling when it starts, waxing and waning and usually goes away after about weeks but some are left with fatigue and arthritis - often have rash and fever which is mostly self limiting
What is the treatment of acute gout?
NSAIDs - quickly and in high dose expect in those with contraindications in this case use prednisolone or colchicine, allopurinol for complicated gout
What are the aims of gout treatment?
No attacks
SUA
What advice is given to gout patients?
Reduce alcohol Reduce diuretics Increase water intake 1g/meat/day/kg Dairy Oysters, tomato's, crustaceans
What is the major co-morbidity of gout?
Metabolic syndrome
What are the rheumatic diseases associated with excess CV risk?
RA, SLE, PsA, ankylosing spondylitis, scleroderma, systemic sclerosis, antiphospholipid syndrome, Gout, vasculitis, undifferentiated inflammatory arthritis
