4.1 Management of acute arthritis

Question 1

What are mono, oligo and polyarthritis?

Answer 1

Mono = 1
Oligo = 2-4
Poly > 4

Question 2

What do you need to do with presentation of acute swelling?

Answer 2

Exclude infection

Question 3

How do infants and toddlers present with acute monoarthritis?

Answer 3

Infants - global sepsis (fever, unwell, dehydrated)

Toddlers with a limp

Question 4

How do adults present with acute monoarthritis?

Answer 4

warm, swollen, red, painful joint, gradual onset, pain is constant, disturbs sleep, poor function

Question 5

What are the most common causes of acute infective monoarthritis and what do you need to look for?

Answer 5

Bacterial - staph aureus, streptococci, resistant organisms

Source of entry of the organism

Question 6

Who most commonly gets acute infective arthritis?

Answer 6

immunocompromised, diabetics, steroid use

Question 7

What is the common community presentation of gout?

Answer 7

Fat, forty, male, wakes up with severe pain in big toe

Question 8

What is the hospital presentation of gout?

Answer 8

Older, either sex, recent trauma, surgery etc. On diuretics, mild CRF, no FH or previous attacks

Question 9

What are the investigations for acute monoarthritis?

Answer 9

Examination (TEMP)
Blood culture, ESR, CRP
Aspiration: ED or US, WCC, crystals, culture,
CXR

Question 10

What should you do if you expect infective monoarthritis?

Answer 10

Start on broad spectrum antibiotics, joint lavage and maybe biopsy

Question 11

What are the two common causes of subacute (days) monoarthritis? and what are the less common causes?

Answer 11

Gout and calcium phosphate deposition disease (pseudo-gout)

Infection, SBE and reactive arthritis, rheumatic fever

Question 12

What is reactive arthritis, what is the presentation and what are the common causes?

Answer 12

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

Question 13

What are the common causes of acute (

Answer 13

Viral, crystal arthritis, RA, SLE

Question 14

What are the common causes of polyarthritis > 6 weeks

Answer 14

RA

OA, PsA, vasculitis, CTD related, SLE

Question 15

What are the viral causes of arthritis?

Answer 15

Parvovirus B19, Rubella and vaccine, Ross river and Barmah forrest, Chikungunya, Hep B and Hep C, Mumps, adenovirus

Question 16

What is the typical presentation of viral arthritis?

Answer 16

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

Question 17

What is the treatment of acute gout?

Answer 17

NSAIDs - quickly and in high dose expect in those with contraindications in this case use prednisolone or colchicine, allopurinol for complicated gout

Question 18

What are the aims of gout treatment?

Answer 18

No attacks

SUA

Question 19

What advice is given to gout patients?

Answer 19

Reduce alcohol 
Reduce diuretics 
Increase water intake 
1g/meat/day/kg 
Dairy 
Oysters, tomato's, crustaceans

Question 20

What is the major co-morbidity of gout?

Answer 20

Metabolic syndrome

Question 21

What are the rheumatic diseases associated with excess CV risk?

Answer 21

RA, SLE, PsA, ankylosing spondylitis, scleroderma, systemic sclerosis, antiphospholipid syndrome, Gout, vasculitis, undifferentiated inflammatory arthritis