DDH/ reactive arthritis Flashcards
1
Q
what is the pathology behind DDH?
A
- shallow acetabulum
- does not adequately cover the femoral head
- leads to easy joint dislocation
2
Q
what are the risk factors (4 Fs)?
other risk factor?
A
- Frank breech position
- Family history
- Female sex
- First born
- oligohydramnios (restricts movement)
- spina bifida and cerebral palsy
3
Q
how might you diagnose DDH in a <3 month old?
in those >3 months old?
A
- Barlow Before
- Ortolanis, reduced
- hip often dislocated in fixed position so Galeazzi sign:
- hips and knees flexed, patient lying supine
4
Q
what is the management of CHD?
A
- immobilise hip joint with a splint (Pavliks harness) for 3 months
- allow development of acetabular rim
- most unstable hips stabilise spontaneously by 2-6 weeks
- surgery is an option for children in whom non operative treatment has failed
5
Q
what is reactive arthritis?
A
- acute inflammatory arthritis, following intercurrent infection
- NO evidence of causative organism in the joint
6
Q
what can cause reactive arthritis?
A
- typically follows 7-10 days after gastroenteritis
- infections: shigella, salmonella, campylobacter, strep
- adolescents: consider sexually acquired urethritis from gonococcal arthritis or chlamydia infection
7
Q
what joints does it tend to involve?
what is reiters disease?
what is the most common risk factor for renters syndrome?
A
- knee> ankle> hip
- triad of: urethritis, conjunctivitis, arthritis
- HLA-B27 allele
8
Q
what 4 things are HLA-B27 linked with?
how long after an infection might a reactive arthritis patient present?
A
- Psoriasis
- Ankylosing spondylitis
- Inflammatory Bowel disease
- Reactive arthritis
- “PAIR”
- 2-4 weeks
9
Q
how might a reactive arthritis patient present?
what might you see on the skin/ mouth?
A
- limping
- inflammation and effusion
- usually unilateral
- low back pain
- malaise/ fatigue/ fever
- erythema nodosum/ apthous ulcers
10
Q
what investigations should you do for reactive arthritis?
A
- blood and synovial fluid cultures (negative)
- FBC, ESR and CRP (both high)
- HLA typing
- culture: stool, throat, urogenital tract to identify causative organism
11
Q
what is the management of reactive arthritis?
A
- rest and aspirate effusion
- physio
- NSAIDs
- intra-articular steroid injection
