Chapter 3: Joint Pain Flashcards
DDx for joint pain
Gout/Pseudogout
Infection (direct or hematogenous)
OA
RA
Tx for acute Gout
NSAIDs (avoided in elderly pts, HF, renal/hepatic disease, PUD), may consider using colchicine, intra-articular steroids
MC sites of infectious joints
Knee, Hip, Shoulder
Risk factors for infectious arthritis
Alcoholism Malignancy Diabetes Hemodialysis HIV Immunosuppressive drugs (corticosteroids) Chronic illness (endocrine, pulm, hepatic) Hemophilia IVDA RA
SXS of septic joint
Limited ROM due to pain
Fever
Joint effusion
In contrast, nearby cellulitis, bursitis, or osteomyelitis will usually maintain ROM of joint
SXS of OA
Found in people over 65yo (but not always)
A/w trauma, h/o repeated joint use, Obesity
Dull, deep, ache-type pain
PE: Bony crepitus on passive ROM
XR findings of OA
XR: bone sclerosis, subchondral cysts, osteophytes
Tx for RA
Depends on stage
PT & OT
DMARDs (sulfasalazine, methotrexate)
+ NSAIDs, steroids, anticytokines (Infliximab, etanercept), topical analgesics
Monitor LFTs
Dx of RA
synovitis (swelling) in at least one joint
all other ddx excluded
Calculated individual score of >6points
Table 3-1 pg44
Tx for chronic gout
Probenecid, Allopurinol
Should not be used during an acute gout attack
Consider short-term steroids once septic arthritis is ruled out
Use immunosuppressive therapy with caution, especially in patients with DM
Tx for septic arthritis
IV abx, surgery/drainage
MRSA requires Vancomycin
Tx of degenerative joint disease
Mobility exercises
Maintenance of adequate ROM
Weight loss
