Ch 21: Arthritis & Back Pain Flashcards
Name a common cause of acute arthritis in young adults.
Hematogenous gonococcal infection
If Gram stains show Neisseria gonorrhoeae, they will appear as….
….gram-negative diplococci within neutrophils.
What is tenosynovitis?
inflammation of the tendon sheath where muscle attaches to bone
The primary (________) site of gonococcal infection is often asymptomatic. If disseminated gonococcal infection is suspected, where else should cultures be obtained from?
mucosal
blood, pharynx, rectum, urethra or cervix
What characteristic pattern is seen in oligoarthritis?
involvement of 1 - 3 joints in an asymmetric pattern
What are the common causes of oligoarthritis?
infection, crystal deposition (i.e. gout and pseudogout), and trauma
If a patient with acute arthritis has acrally located joints that are affected (i.e. wrist, elbow, knee, or ankle), what procedure should be done in the emergency department?
arthrocentesis
A specialist and/or ultrasound guidance should be considered for arthrocentesis of the _________ and ____.
shoulders and hips
Name the 4 classes of synovial fluid.
normal class I -- noninflammatory class II -- inflammatory class III -- septic class IV -- hemorrhagic
Describe normal synovial fluid.
high viscosity transparent clear with < 200 leukocytes per mL and < 25% of those leukocytes are neutrophils negative gram stain and culture
Describe class I (noninflammatory) synovial fluid.
high viscosity transparent light yellow with < 200 - 2,000 leukocytes per mL and < 25% of those are neutrophils negative gram stain and culture
Describe class II (inflammatory) synovial fluid.
low viscosity cloudy dark yellow 200 - 50,000 leukocytes per mL and > 50% of those are neutrophils negative gram stain and culture
Describe class III (septic) synovial fluid.
low viscosity cloudy dark yellow usually > 50,000 leukocytes per mL and > 50% of those are neutrophils gram stain and culture usually positive
Describe class IV (hemorrhagic) synovial fluid.
variable viscosity cloudy pink to red usually > 2,000 leukocytes per mL with lots of RBCs often > 50% of those are neutrophils negative gram stain and culture
What do fat globules in the synovial fluid indicate?
They strongly suggest intra-articular fracture.
When crystals are seen on synovial fluid analysis, how is gout differentiated from pseudogout?
polarizing microscopy
Is it possible for a class I or class II synovial fluid to show bacteria on Gram stain or culture?
yes, but it is rare
What percent of cases of gonococcal infection have a positive culture or Gram stain?
25%
Acute arthritis in the presence of normal joint fluid usually indicates….
…..trauma or osteoarthritis.
What conditions are associated with inflammatory (class II) synovial fluid?
acute gout, pseudogout, Reiter syndrome, rheumatoid arthritis, rheumatic fever
A tear in the ________ ________ ________ is the most common cause of hemarthrosis in the knee when no fracture is present.
anterior cruciate ligament
Hemorrhagic synovial fluid may also be seen in what other 2 conditions?
hemophilia and synovial neoplasms
________ fractures are particularly difficult to locate and require careful correlation with clinical findings (e.g. localized tenderness in the anatomic ________).
Scaphoid
snuffbox
The symptoms and signs of acute gouty arthritis include warmth, _________, induration, and extreme ____ in a joint, most commonly the ___________________ joint of the great toe. The next most commonly involved joint is the ____.
hyperemia, pain
metatarsophalangeal
knee
It is not helpful to order a ____ ____ _____ in an acute attack of gout.
uric acid level
NSAIDs may be used for the treatment of gout, namely ____________, however _______ is contraindicated because small doses may cause _____________.
indomethacin
aspirin
hyperuricemia
What is the recommended dosing strategy of indomethacin in treating acute gout?
50 mg, PO, Q 8 hrs for 2 days or until pain is tolerable, then rapidly taper dose to discontinuation.
Indomethacin should not be used in patients with ______ _____ disease and reducing dosing is required in patients with _______ or _____ impairment.
peptic ulcer
hepatic, renal
Name 3 other NSAIDs which are alternative to indomethacin.
ibuprofen
naproxen
ketorolac
In select patients with gastrointestinal contraindications, ____ __________ may be a viable alternative. For example, _________ (Celebrex), give 800 mg once, followed by 400 mg on day 1, then 400 mg BID x 7 days.
COX-2 inhibitors
celecoxib
Response to __________ strongly supports a diagnosis of gout.
colchicine
What type of drugs can be used in patients with gout who cannot take NSAIDs or colchicine?
Alternatively, a single dose of ___________________ _______ can be used in the patient who cannot tolerate oral medications to boost the patient’s endogenous steroid production and provide relief.
corticosteroids
adrenocorticotropic hormone
What kind of crystals are found in the joint of a patient with pseudogout?
calcium pyrophosphate
Pseudogout differs from gout in that the most commonly affected joint is….
….the knee.
What is chondrocalcinosis?
Chondrocalcinosis is a finding on imaging studies and means deposition of calcium in the cartilage. Calcium depositions have been found in other soft tissues as well.
