Arthralgias

Question 1

disseminated gonococcal infection

Answer 1

purulent arthritis without skin lesions

triad of tenosynotivitis, dermatitis (painless pustular lesions) and migratory asymmetric polyarthralgias

Question 2

triad of disseminated gonococcal infection

Answer 2

purulent monoarthritis

OR triad of tenosynovitis, dermatitis, migratory polyarthalgia

Question 3

diagnosis of disseminated gonococcal infection

Answer 3

detection of neisseria gonorrhea in urine, cervical or urethral sample
culture of blood and synovial fluid (less sensitive)

Question 4

treatment of disseminated gonococcal infection

Answer 4

3rd generation cephalosporin IV AND oral azithromycin for 7-14 days - longer for septic arthritis.

also treat for chlamydia with azithromycin or doxycyline and treat sexual partners.

Test for HIV and syphilis too

Question 5

painless pustular lesions, asymmetric polyarthralgias and tenosynovitis and sometimes a fever

Answer 5

disseminated gonococcal infection
seen in young sexually active men and women

don’t recall a UTI and more often seen in women

Question 6

which joints are affected in disseminated gonococcal infection

Answer 6

knees, ankles, and wrist joints

Question 7

diagnosis of disseminated gonococcal infection

Answer 7

will need drainage of purulent arthritis with synovial fluid analysis.

on synovial fluid analysis may have 50K cells but many will have <10K cells.

Blood cultures may be positive but can be negative.

best way is isolation of gram neg diplococcus from mucosal sites (pharyngeal and rectal or urethral or cervical swabs)

Question 8

what should be tested for someone who has recurrent disseminated gonococcal infection?

Answer 8

check for terminal complement deficiencies

Question 9

reactive arthritis is associated with

Answer 9

spondyloarthropathy that resembles Anklyosing spondylitis with inflammatory back pain, enthesitis and peripheral arthritis.

But follows chlamydial trachomatis infection than gonorrhea urethritis

Question 10

difference between reactive arthritis and disseminated gonococcal infection?

Answer 10

reactive arthritis - mimic of ankylosing spondylitis and seen with chlamydia infections

disseminated gonococcal infection - see purulent monoarthritis or triad of tenosynovitis, dermatitis, and migratory polyarthralgias.

Question 11

what is preceding infection before we see reactive arthritis?

Answer 11

gastroenteritis - Salmonella, Shigella, Yersinia, Campylobacter, C diff

GU infection: chlamydia trachomatis

Question 12

MSK manifestations of reactive arthritis:

Answer 12

asymmetric, peripheral oligoarthritis
enthesitis
dactylitis

Question 13

Extraarticular symptoms of reactive arthritis:

Answer 13

ocular: uveitis, conjunctivitis
genital: urethritis, cervicitis, prostatis
dermal: keratoderma bennorrhagicum, circinate blanitis
oral ulcers

Question 14

Management of reactive arthritis

Answer 14

if they have chlamydia, non self limiting GI infection, give antibiotics

Treat with NSAIDs

If not able to get NSAIDs or contraindication:

intraarticular glucocorticoids, then systemic glucocorticoids then dx modifying antirheumatic drugs

Question 15

Reiters syndrome

Answer 15

reactive arthritis

Question 16

who gets reactive arthritis?

Answer 16

young adults and pts who have asymmetrical oligoarthriits after preceding GU and GI infection.

Question 17

diagnosis of reactive arthritis:

Answer 17

clinical diagnosis and it’s no gold standard diagnosis. need to rule out other causes

Question 18

Prognosis of reactive arthritis

Answer 18

generally self limiting but NSAIDs can help with pain. don’t help shorten or alter dx course.

Question 19

when to use methotrexate or sulfasalazine or anti TNF alpha agents for reactive arthritis:

Answer 19

only if they develop a chronic inflammatory arthritis refactory to NSAIDs or steroids

Question 20

keratoderma blenorrhagicum

circinate balanitis

Answer 20

think reactive arthritis

Question 21

Lyme dx arthralgias affect:

Answer 21

large joints (knees) .

Question 22

reactive arthritis has

Answer 22

mono or oligoarticular arthritis usually of lower extremities

can see dactylitis or enthesitis can be present

see erythema nodosum nail pitting and rarely cardiac manifestations.

can see elevated acute phase reactants and elevated WBC in synovial fluid analysis (NO growth on synovial culture)