Acute Joint pain Flashcards
Which diagnosis MUST BE excluded in a patient with acute joint pain
Septic arthritis
Can destroy articular cartilage within days - has mortality of 10% due to bacteraemia
What are the main causes of a single, acutely painful joint?
- Articular - trauma, gout, pseudogout, septic arthritis, seronegative spondyloarthropathy, transient synovitis
- Peri-articular - ligament injury, tendinitis, bursitis, fasculitis
- Non-articular - nerve entrapment, radiculopathy
Pain that worsens with movement and improves with rest is likely to be noninflammatory/inflammatory
Non-inflammatory
Acute onset pain (few hours) is more likely to be?
Septic arthritis, gout, pseudogout
Chronic onset joint pain suggests?
Osteoarthritis
What are the RFs for gout
Thiazide diuretics, recent heavy alcohol intake, chronic renal failure, chemotherapy, hx of renal stones, PMH of gout
What are the RFs for septic arthritis
Immunosuppression and prosthetic joints
What are the RFs for haemarthrosis
Coagulopathy (haemophilia), anticoagulant use (typically warfarin) or trauma
Which type of arthritis can develop after recent GI or urethral infection
Reactive arthritis
Involvement of several joints simultaneously suggests a presentation of?
Rheumatoid or psoriatic arthritis
If the joint is diffusely inflamed (red, hot painful), and there is pain on passive and action motion, what condition is It likely to be?
Articular condition (e.g. gout/pseudogout/septic arthritis)
If there is a focal point of tenderness and pain is much worse on active movement than passive movement, what condition is it likely to be?
Periarticular condition (e.g. bursitis/tendonitis)
What do tophi suggest?
Chronic gout
Subcutaeneous nodules (on the elbows and ears are called rheumatoid nodules). What are these indicative of?
Rheumatoid arthritis
In the nails: pitting, sublingual hyperkeratosis, and oyncholysis are all signs of?
Psoriasis which indicates psoriatic arthritis
Lung signs suggestive of fibrosis (e.g. end inspiratory fine crackles/clubbing) could suggest?
Rheumatoid arthritis
When unsure about septic arthritis or if it is a crystal arthropathy, what do you do
Arthrocentesis
Crystals after investigation indicate that gout is present. How to distinguish the types of gout?
Urate = gout
Calcium pyrophosphate = pseudogout
Cloudy aspirate (from arthrocentesis) with high WCC, high neutrophils, and bacteria visible on microscopy indicate?
Septic arthritis
If fat globules are present in haemarthrosis, what does this indicate
Fracture/trauma
After arthrocentesis, if there are no crystals/blood/infection but there is WCC raised, what could this be?
Reactive arthritis, rheumatoid arthritis, psoriatic arthritis, rheumatic fever
The presence of irate crystals and polymorphonuclear cells (WCC) is what diagnosis
Acute gout
Describe the acute and chronic management of gout
Acute: colchicine (contraindicated if renal/hepatic impairment), NSAIDS, corticosteroid injections
Chronic: decrease urate production (allopurinol or febuxostat), increase urate excretion (sulfinpyrazone and probenecid), increase degradation of urate (rasburicase)
Allopurinol and febuxostat work how?
Xanthine oxidase inhibitors
If a patient has developed an acutely painful joint, with evidence of trauma, the joint is red, hot, swollen and tender - painful to both active and passive movement. The patient is pyrexic and has yellow, turbid aspirate upon arthrocentesis. What must you be worried about?
What do you do?
Septic arthritis
Start analgesia, take blood cultures and start broad spectrum antibiotics
Once septic arthritis confirmed by microbiologist, do joint aspiration and lavage via orthopaedic surgeons
A patient has history of urethral and eye symptoms, as well as an inflamed joint. What is the diagnosis?
Reactive arthritis
Typically causes uveitis, urethritis, arthritis (can’t see, can’t pee, can’t climb a tree)
