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Z Year3 Clinical Presentations > Acute Joint Pain 2 > Flashcards

Acute Joint Pain 2 Flashcards

1
Q

What are the crystals like in gout?

A
  1. urate crystals
  2. negatively birefringent
  3. needle shaped
  4. lots white cells (PMNs)
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2
Q

What are the crystals like in psuedogout?

A
  1. calcium pyrophosphate crystals
  2. positively birefringent
  3. rhomboid
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3
Q

How might septic arthritis show up in aspirate?

A
  1. cloudy aspirate with high WBC
  2. high neutrophil count
  3. bacteria visible on micrcosopy
  4. positive cultures
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4
Q

When might the WBCC be high in aspirate apart from septic arthritis?

A

crystal arthropathies

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5
Q

What would haemarthrosis suggest?

A

trauma with or without fracture

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6
Q

If fat gobules are present in aspirate what does this suggest?

A

fracture

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7
Q

If there is an absence of crystals, blood and infection but white cells present in aspirate what conditions could this suggest?

A
  1. reactive arthritis (Reiter’s syndrome)
  2. enteric arthropathy (due to IBD)
  3. rheumatoid arthritis
  4. psoratic arthritis
  5. rheumatic fever
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8
Q

What does non-inflammatory aspirate (clear with normal WCC) suggest?

A

trauma or osteroarthritis

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9
Q

Although arthrocentesis is the most appropriate 1st line treatment what other investigations can be considered for acute joint pain?

A
  1. cultures
  2. blood
  3. plain radiographs
  4. MRI
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10
Q

What swabs and cultures do you do and why?

A

skin lesions or throat, urethra, cervix and rectum if gonoccocal arthritis possibility

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11
Q

When would you do blood cultures?

A

of sus of sepsis

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12
Q

What bloods do you order for acute joint pain?

A
  1. FBC, CRP and ESR
  2. PT and APTT
  3. Rheumatological investigations
  4. Serum urate
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13
Q

Why do you do FBC, CRP and ESR?

A
  1. reveal any inflammatory or infective

2. osteomyelitis deranged ESR and CRP but not always raised WCC

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14
Q

When do you do PT and APTT?

A

if arthrocentesis reveal a haemarthrosis in absence of trauma sufficient should be requested to screen for coagulopathy

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15
Q

What rheumatological investigations can be requested?

A
  1. rheumatoid factor
  2. anti-CCP antibodies
  3. ANA
  4. other autoantibodies
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16
Q

When would you request serum urate?

A

non-acute setting

17
Q

What can a plain radiograph show that otherwise may be hard?

A
  1. Unsuspected fracture
  2. Atraumatic avascular necrosis of femoral head (Perthe’s disease) or navicular in children (Kohlers disease)
  3. Effusion that not clinically obv (elbow)
  4. Erosion of joint surfaces from aggressive septic arthritis or inflammatory, autoimmune arhtropathy
  5. Chondrocaclinosis (pseudogout)
18
Q

When would you carry out an MRI?

A
  1. If suspect soft tissue injury (meniscal tear in knee)

2. If suspect bony pathology not on XR (e.g. osteomyelitis

19
Q

What joints does gout affect?

A

big toe and knee mostly

20
Q

Even if you are really sure it is gout what else must you do?

A

gram stain and cultures to exclude septic arthritis

21
Q

What medications are used in the acute treatment of gout?

A
  1. Colchicine
  2. NSAIDs
  3. Corticosteroid injection
22
Q

When do you administer colchicine?

A

within 24hr

23
Q

When is colchicine contraindicated?

A

renal or hepatic impairment

24
Q

What are the side effect of colchicine?

A

severe GI side effect so use in low dose

25
Q

When are NSAIDs contraindicated?

A
  1. peptic ulcer diseas
  2. acute or chronic renal failure
  3. heart failure
  4. pregnancy
  5. sometimes asthma
26
Q

How are corticosteroids administered?

A

injected intro joint or given systemically

27
Q

When are corticosteroids used?

A

patients who can’t take NSAIDs or colchicine

28
Q

Why do you not give aspirin in gout?

A

can cause hyperuricaemia by impairing urate excretion (high dose fine) - but carry on taking as cardio risk arguable more important

29
Q

For chronic treatment of gout what do you need to investigate for?

A

hyperuricaemia and if present prescribe medication

30
Q

What medication can be prescribed for chronic gout and why?

A
  1. Decrease urarte production: allopurinol and febuxostat
  2. Increase urate excretion: sulfinpyrazone and probenecid
  3. Increase degradation of urate: rasburicase
31
Q

How does allopurinol and febuxostat work?

A

inihibitors of xanthine oxidase and limit production of urate during degradation of nucelic acids

32
Q

What are the contraindications of allopurinol and febuxostat?

A

dose must be reduced if renal or hepatic impairment and stopped if causes rash

33
Q

What is co-prescribed with allopurinol?

A

colchicine co-prescribed with allopurinol for 6 weeks as initial dose of allu can result in acute gout

34
Q

How does sulfinpyrazone and probenecid work?

A

inhibit reuptake of urate at PCT in kidneys, increasing urate excretion

35
Q

When is sulfinpyrazone and probenecid used?

A

patient cannot tolerate allopurinol

36
Q

When is rasburicase used?

A

uricase enzyme that adminsters to patients with severe hyperuricaemia due to chemotherapy

Z Year3 Clinical Presentations (37 decks)

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