Acute joint pain & swelling profoma

Question 1

Presentation of joint pain?

Answer 1

Pain - often on movement and stiffness at end of day.

Gradual onset - sepsis, haemarthrosis, OA, psoriatic.

Fast onset - gout, pseudogout.

Location:
- Shoulder- septic or inflammatory arthritis
- Wrist- pseudo gout or inflammatory arthritis
- Hip- OA, septic arthritis
- Ankle- Pseudogout, septic arthritis, gout, reactive arthritis
- Knee- OA, RA, Pseudogout, septic arthritis, gout, reactive arthritis

Question 2

Initial investigations for joint pain?

Answer 2

1. History:
   -pattern of joint involvement
   - speed of onset
   - age & gender of the patient
   - prior episodes
2. Joint examination
3. Blood tests - FBC, WCC, ESR, CRP, serum urate, serum calcium, prolactonin test (differentiates btw infective & inflammatory cause), clotting screen (if haemarthrosis is suspected).

NOTE: prolactonin is high in bacterial infection.

4. Imaging - x-rays, ultrasound (good for effusions)- to exclude tumour
5. Synovial fluid analysis (aspirate):
   - Culture
   - Gram stain
   - Polarised light microscopy
6. Blood cultures if septic arthritis suspected.

Question 3

Key differential diagnosis for acute mono- arthritis

Answer 3

Common:
- Gout
- Pseudo-gout
- Trauma
- Haemarthrosis
- Spondyloarthritis
- Psoriatic arthritis
- Reactive arthritis

Less common:
- Rheumatoid arthritis
- Juvenile idiopathic arthritis
- Foreign body reaction
- Septic arthritis
- Osteoarthritis - because it’s usually not acute

Question 4

Management for joint pain & swelling

Answer 4

Conservative
- Exercise - local muscle strengthening & aerobic fitness.
- Weight loss
- Footwear
- Aids & braces

Pharmacological
- Paracetamol
- NSAIDS + PPI
- Opioid analgesia
- Topical NSAIDS
- Intraarticular injections