An acute hot swollen joint

Question 1

What are the differentials for an acute hot swollen joint?

Answer 1

• septic arthritis
• crystal arthropathy (gout, pseudogout)
• inflammatory arthritis
• haemarthrosis (bleeding into the joint)
• transient synovitis
• reactive arthritis

Question 2

What joint does gout most commonly affect?

Answer 2

• 1st metatarsophalangeal joint of the foot

Question 3

What joints does pseudogout (CPPD) most commonly affect?

Answer 3

• wrist and knee

Question 4

Which patients are at an increased risk of developing acute haemarthrosis?

Answer 4

• patients with bleeding disorders (eg. heamophilia) or on anticoagulants (eg. warfarin)

Question 5

What medications increase risk of a patient developing gout?

Answer 5

• diuretics (particularly thiazides), and low-dose aspirin
• (can increase uric acid lvls)

Question 6

What are gouty tophi?

Answer 6

• gout tophi: deposits of monosodium urate crystals

Question 7

What is the important condition to rule out in acute monoarthritis?

Answer 7

• septic arthritis
• prosthetic joint infection
• note: both require surgical washouts and antibiotics

Question 8

What are the benefits to aspirating a joint?

Answer 8

• diagnostic (culture, stain, microscopy)
• also good for the joint to remove all the fluid (especially pus)