Arthritis Flashcards
Which joint is commonly affected in septic arthritis?
The knee
What are the risk factors for septic arthritis?
Imunouppression
Pre existing joint disease
Diabetes
Recent joint surgery
Prosthetic joints
IV drug use
What investigation would you do if you suspected septic arthritis?
Obs
FBC
History
Joint aspiration of synovial fluid for MICROSCOPY and CULTURE do not wait to treat before results come back if you suspect septic arthritis
What in the history may point you toward septic arthritis?
Very unwell
Other infections - chest infection / gastro infection / central line / skin infections
If a prosthetic joint is involved in septic arthritis who must you refer to?
Orthopeadics
Describe a common pattern of disease in serum negative spondyloarthropathies
Asymmetrical, large joint, mono/oligoarthropathy
What are the four main spondyloarthropathies?
- Psoariatic arthritis
- Enteric arthritis
- Reactive arthritis
- Ankylosing spondylitis
What are the six common features of sponyloarthropathies?
- Human Leukocyte Antigen B27 (HLA-B27) positive increases the risk of sponyloarthropathies
- Axial arthritis - pain in the spine / sacroiliac joints
- Asymmetrical large joint oligo/mono arthritis
- Enthesitis - inflammation of the tendons
- Dactylitis - inflammation of a single digit
- Extra articular features
What are the extra articular features of sponyloarthropathies
- Uveitis - red eye
- Oral ulcers
- Aortic valve incompetence
- IBD
What does ankylosis mean?
Fusion of the bones causing stiffening of the joints
What are the main features of ankylosing spondylitis?
Male Under 30 Lower back pain of a gradual onset Worse at night Spinal stiffness Relieved by exercise Reduced back flexion
How would you make a diagnosis of ankylosing spondylitis?
Clinical picture
Schobers test
X Ray showing sacrolitis or erosions and reduced joint space
How do you perform schobers test?
Looks for reduced flexion in the spine
Mark a point 10cm above the dimples of venus
On forward flexion this should increase to over 15 cm
What level do the dimples of venus correlate too?
L5 - posterior superior iliac spine
How do you manage ankylosing spondylitis?
Conservative - physio therapy and exercise
Analgesia and anti inflammatories - NSAIDS
Biologics
Which medications do not have an affect on ankylosing spondylitis?
DMARDS and STERIODS
What extra articular features are associated with psoariatic arthritis?
Nail changes - leukonychia / pitting
Synovitis
Dactylitis
Rashes
What is included in crystal arthopathies?
Gout and psuedogout
What is the cause of gout
Build up of urate crystals in the joint space, due to excess urate
Risk factors for gout
Male
Overweight
Dietary purine - red wine, meat
Decreased kidney function
Diuretic use
Infection
Dehydration
Where does gout most commonly occur?
The metacarpal phalangeal joint of the big toe
Ankle
Foot
Wrist
Are there any complications of gout?
Chronic renal failure due to build up of urate
What is the gold standard investigation for gout?
Synovial fluid aspiration - gram stained / cultured / microscopy
Looks at the bacteria and the cells for mono sodium urate
What is the treatment for gout?
Naproxen - fast acting oral NSAID
When wwould you not use naproxen for gout?
If it is contra indicated as in chronic renal failure
What would you prescribe if naproxen is contra indicated?
Colchicine
What is the common side effect of colchicine
Diarrhoea
When and what do you prescribe for prophylaxis of gout?
Allopurinol
When 2 attacks or more in a year
1 attack a year + risk factors such as tophi present, poor kidney function, long term diuretic treatment
