Acute Swollen Joint Flashcards
What to think about in clinical features
Onset, site, timeframe and precipitating factors like trauma or surgery.
Ask about exacerbating factors and relieving ones.
Ask about level of pain and ability to weight bear.
Ask about systemic symptoms.
Ask about GI (enteropathic arthritis) or genitourinary symptoms (reactive arthritis) or other skin changes (psoriatic arthritis).
Ask about previous episodes and PMH + DH.
Initial assessment.
Look, feel and move joint.
Inspect for redness, swelling or skin changes + compare to contralateral joint.
Check for focal tenderness and joint effusion.
Inspect rest of the body, other joints or any systemic signs.
Investigations
Routine bloods, FBC and CRP
ESR if rheumatological cause is suspected.
Serum urate if gout (even if it serum urate might be normal)
Plain X-ray should be obtained, especially if there is trauma involved.
What is the most important investigation in acute monoarthritis?
Joint aspiration
What is assessed on joint aspiration?
Opacity, colour and presence of frank pus on aspirate
It is also sent for WCC and microscopy + culture and sensitivity as well as light microscopy.
Dx
Septic arthritis
Haemarthrosis
Crystal arhtropathies
Rheumatological causes
OA
MSK injury like ligamentous/tendon injury or bursitis
Spondyloarhtropathies like RA, AS and PA
What is haemarthrosis?
Bleeding into a joint cavity.
Most common cause of haemarthrosis.
Traumatic injury
Can also happen in bleeding disorders like haemophilia or if the patient is on anticoagulants.
What other associated injury presents commonly with haemarthrosis?
Ligamentous or meniscal injury.
ACL contains genicular artery e.g.
Ix in Haemarthrosis
Routine bloods including clotting and plain X-ray.
Joint aspiration
Management of haemarthrosis
RICE initially
Sufficient analgesia
Majority of cases can be managed conservatively but be mindful of any underlying coagulopathy.
