Acute Joint Pain Flashcards
What is the ‘must exclude diagnosis’ in any patient presenting with acute joint pain?
Septic arthritis
Construct a differential diagnosis for acute joint pain by dividing it into articular, peri-articular and non-articular pathology.
- Articular Trauma Gout Pseudogout Septic arthritis Seronegative spondyloarthropathies Transient synovitis Others: amyloidosis, sarcoidosis, vasculitides, SLE, haemarthrosis Peri-articular Ligament injury Tendinitis Others: Bursitis, fasciitis, epicondylitis - Non-articular Nerve entrapment Radiculopathy Others: bone malignancy, osteomyelitis
List the seronegative spondyloarthropathies.
Reactive arthritis
Ankylosing spondylitis
Psoriatic arthritis
Enteropathic arthritis
List some key features of the history that are important to ask the patient about.
Pain Trauma Risk factors for gout Risk factors for septic arthritis Risk factors for haemarthrosis
Describe different patterns of pain and how they relate to the causes of joint pain.
Worse with movement + better with rest = non-inflammatory (e.g. osteoarthritis)
Acute-onset = septic arthritis, gout/pseudogout, trauma
Insidious onset = bursitis, tendonitis (overuse)
Chronic onset = osteoarthritis
List some risk factors for gout.
Thiazide diuretics
Chemotherapy
Chronic renal failure
Recent heavy alcohol intake
List some risk factors for septic arthritis.
Prosthetic joints
Immunosuppression
Trauma
List some risk factors for haemarthrosis.
Coagulopathy
Anticoagulants
Trauma
List some significant features of the past medical history of a patient with joint pain.
Recent GI or urogenital infections (reactive arthritis or septic arthritis)
Previous episodes of joint pain
Rheumatological disease
Which diseases are associated with sequential involvement of several joints?
Septic arthritis (gonococcal) Rheumatic fever
Which diseases are associated with simultaneous involvement of multiple joints?
Chronic polyarthritis (e.g. rheumatoid arthritis, psoriatic arthritis)
List some key features of the drug history of a patient with joint pain.
Thiazide diuretics, aspirin and chemotherapy – increases uric acid levels and precipitates gout
Steroids – increase risk of atypical fractures
Outline a basic approach to joint examination.
Look
Feel
Move
Describe briefly how articular conditions can be distinguished from peri-articular conditions on joint examination.
Articular – more likely to see diffuse joint inflammation and pain on active AND passive motion
Peri-articular – focal point of tenderness on palpation and pain is usually much worse on active movement
List some features of joint disease that you may see on the skin of a patient.
Tophi
Rheumatoid nodules
Rash (e.g. psoriasis, SLE)