Diagnostic approach of joint disease Flashcards
What is the presentation for septic arthritis?
mostly monoarthropathy
possible pyrexia
severe lameness often one limb
single swollen limb, can have mild effusion through to marked cellulitis of entire limb
HX of previous sx, wound, source of infection?
What is the presentation for immune mediated polyarthritis?
Sytemic: multiple joints
possible pyrexia
general stiff gait, lower grade
multiple painful joints with mild-moderate effusion
often other signs of illness: prostatitis, GI dz, travel hx, etc.
What is the main part of joint disease investigation?
arthrocentesis
What are the characteristics of a normal joint synovial fluid?
clear/pale yellow
transparent
very high viscosity
2-2.5g/dl protein
<1000/mm3 white cells
<5% neutrophils
>95% mononuclear cells
>90% serum value glucose
What are the characteristics of degenerative joint disease synovial fluid?
yellow
transparent
high viscosity
2-3 protein
variable white cells
<10% neutropjils
high mononuclear cells
What are the characteristics of immune mediated arthritis synovial fluid?
yellow +/- blood tinged
transparent or opaque
low/very low viscosity
2.5-3 protein
high white cells
variable neutrophils
variable mononuclear cells
What are the characteristics of bacterial infective arthritis synovial fluid?
yellow +/- blood tinged
opque
very low viscosity
high >4 protein
high white cells
high neutrophils
low mononuclear cells
<50% serum value glucose
When does synovial fluid have a higher lactate concentration?
in spetic arthritis
What causes immune mediated polyarthritis IMPA?
the body’s immune system fails to recognise its own tissue components and clones of potentially autoaggressive cells originally inactivated in the thymus proliferate
or
reaction is not only inappropriate but over the top and doesn’t know when to stop: hypersensiticity reaction type 3
What is the usual history presentation for IMPA?
acute or chronic
stiffness usually more severe and longer lasting than OA, can’t just walk it off
potential travel hx
medications and response?
underlying disease?
What are the clinical signs indicating IMPA?
gait: stiffness, difficulty rising, shifting lameness
multi-system: pyrexia, depression vs underlying disease
effusion, joints symmetrical???, often carpi/tarsi
range of motion, pain, heat swelling +/- crepitus
What are the type of IMPA?
non-associative/primary/idiopathic: no known cause
associative/secondary: reaction to underlying disease (remote bact. infection, GI dz, neoplasia, etc)
MUST TX underlying dz!
What is the diagnostic approach for IMPA cases?
look for underlying disease to determine if associative vs non-associative
bloods, urine
C reactive protein
imaging
What is the erosive form of IMPA?
not common
chronic synovitis leads to production of proliferative granulation tissue (pannus) that invades articular cartilage and can erode sub-chondral bone
pannus+infl. = proteases/collagenases enzymes causing further joint destruction
What is the treatment for IMPA?
initial stages: analgesia AVOID Nsaids
treat underlying cause
if non-associative/idiopathic: prednisolone and slowly taper it off
