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MSK/Rheum path > Infectious arthritis > Flashcards

Infectious arthritis Flashcards

1
Q

What is significant about acute bacterial arthritis?

A

medical emergency warranting rapid, accurate Dx and immediate Tx and is usually result of bacteremic seeding from S. aureus (esp in adults)

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2
Q

What are poor prognostic factors in bacterial joint infections?

A

old age, RA, infection in prosthetic joint

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3
Q

What is the proper Tx for patients with early prosthetic joint infections?

A

debride; ATBx, implant retention

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4
Q

What is the proper Tx for late prosthetic joint infections?

A

ATBx Tx directed at isolated organism w/ removal of prosthesis before reimplantation of new one

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5
Q

Who is at highest risk for polyarticular septic arthritis?

A

neonates; sickle cell anemia; RA patients; Neiserria organisms along with salmonella

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6
Q

T/F bacterial arthritis is most commonly monoarticular

A

true

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7
Q

Classic presentation on nongonococcal arthritis

A

acute onset of pain, swelling and decreased ROM of single joint with large joints more commonly affected that is typically seen in immunocompromised/sensitive patients

hips in infants and small children

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8
Q

What should be done on all patients who present with an inflamed joint?

A

arthrocentesis and synovial fluid analysis

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9
Q

Who is at highest risk for gonococcal arthritis?

A

sexually active young adults

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10
Q

How does gonococcal arthritis present?

A

1) fever, vesiculopustular skin lesiom, tenosynovitis, polyarthralgia
2) prevalent arthritis of knee, wrist or ankle while more than 1 joint may be affected

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11
Q

How long should the duration of antibiotic Rx be for bacterial arthritis?

A

2-6 wks for non-gonococcal septic arthriitis

1 week for gonococcal arthritis with ceftriaxone use

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12
Q

Define lyme disease manifestations

A

expanding macular skin lesion=> erythema migrans;

50% have musculoskeletal signs

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13
Q

What is key for the host in defense against lyme disease?

A

IgG containing immune complexes and cryoglobulins are key;

secondary are Th1 and Th17 cells mediating Lyme arthritis

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14
Q

How does a mycobacterial infection affect the bones and joints?

A

chronic localized infection involving the spine, less often the hip or knee

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15
Q

Why are musculoskeletal mycobacterial infections difficult to diagnose?

A

rarity of disease that many lack the pain, fever, chills and other Sx associated with bacterial infections

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16
Q

Clinical presentation of spinal TB

A

localized pain that may or may not be associated with low grade fever, weight loss and nonspecific constitutional Sx

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17
Q

How does TB osteomyelitis begin?

A

hematogenous implantation of organizing in medullary area and metaphyseal involvement(common) spreading through the growth plate

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18
Q

What is the most common presentation in TB osteomyelitis?

A

bone pain most common

draining sinus, abscess formation, local swelling, tenderness are common but may be delayed many years

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19
Q

What should be considered in patients from endemic areas who present with multiple destructive skeletal lesions?

A

multifocal osteoarticular TB

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20
Q

How does septic arthritis from TB typically present?

A

monoarticular arthritis typically of large joints such as hip/knee

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21
Q

T/F in TB associated with septic arthritis, acid fast bacilli are typically present

A

false, only 10-20%

synovial fluid is typically positive for culture

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22
Q

What are the tuberculous spondylitis sites of involvement?

A

1) vertebral body
2) posterior osseous or ligamentous structures
3) prevertebral tissues
4) extension to intervertebral disk
5) subligamentous spread

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23
Q

Who is at risk for latent TB reactivation?

A

patients with systemic rheumatic disease

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24
Q

What molecule plays a key role in granuloma formation and stabilization?

A

TNF-a

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25
Q

Define Poncet’s disease

A

aseptic inflammatory polyarthritis occuring in presence of active TB commonly in knee, ankles and elbows

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26
Q

In contrast to TB, nontuberculosis mycobacteria is likely to cause what?

A

tenosynovitis, synovitis or osteomyelitis and LESS LIKELY to cause spinal infection

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27
Q

How can nontuberculosis mycobacteria be distinguished from TB with regards to musculoskeletal infections?

A

they cannot be distinguished so correct diagnosis requires tissue biopsy and culture

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28
Q

What is critical in proper diagnosis of fungal infections?

A

exam and culture of infected tissue

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29
Q

What types of fungal infections are likely to cause osteomyelitis?

A

coccidioidomycosis, blastomycosis, cryptococcosis, candidiasis

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30
Q

What types of fungal infections are likely to cause fungal arthritis?

A

sporotrichosis, cryptococosis, cocidioidomycosis, blastomycosis, candidiasis

31
Q

Why is diagnostic confusion of coccidioidomycosis present?

A

delayed dissemination after primary infection along w/ atypical presentation

32
Q

What are the most common manifestations of osteoarticular disease associated with blastomycosis?

A

bone pain, swelling and soft tissue abscesses

33
Q

How will arthritis present associated with blastomycosis?

A

monoarticular in knee, ankle and elbow

34
Q

What will synovial histology show if positive for blastomycosis?

A

epithelioid granulomas with budding yeast forms

35
Q

How does cryptococcal arthritis present?

A

overall a rare involvement but indolent monoarticular arthritis in 60% and polyarthritis in remainder

36
Q

What types of bone lesions are associated with cryptococcal infections? what will probably be in the DDx?

A

osteolytic lesions for bone infection;

DDx may be confused with metastatic neoplasm

37
Q

What is a serious complication of candidiasis? why?

A

osteomyelitis => due to hematogenous dissemination in adults/children

commonly located in 2 adjacent vertebrae or in single long bone

can infect older prosthesis

38
Q

What is the clinical presentation of candidiasis?

A

typically arthritis in the knee causing localized pain and bone changes demonstrated in radiographs of symptomatic site

39
Q

What is important for sporotrichosis articular infection?

A

propensity to spread to adjacent soft tissue forming draining sinuses and constitutional Sx are unusual

40
Q

Sporotrichosis synovitis is characterized by what?

A

destructive pannus and nonspecific granulomatous or non-granulomatous inflammation

41
Q

What disease likes bone and cartilage leading to what 2 diseases?

A

Scedosporium prolificans leading to both septic arthritis and osteomyelitis

42
Q

What is a key feature in the relationship of HIV infection and rheumatic diseases?

A

CD4 mediated diseases like RA and SLE go into remission w/ disease activity and flare w/ anti-retroviral Tx

43
Q

What can be attributed to HIV-associated arthralgias?

A

circulating viral and host immune complexes owing to HIV infection or others such as Hep C

44
Q

Define painful articular syndrome with HIV associated bone and joint disease

A

self limited syndrome occurring in late stage HIV lasting 24 hr w/ few clinical findings with no known cause but commonly affecting knees

45
Q

Define HIV associated arthritis

A

majority of HIV patients get this w/ OLIGOARTHRITIS usually in lower extremities that is self limited

46
Q

Define REactive arthritis occurring in HIV infection

A

associated w/ HLA-B27 presenting in LE peripheral arthritis w/ mucocutaneous features but less axial involvement

47
Q

Psoriasis and psoriatic arthritis in HIV patients

A

polyarticular and lower limb progressive disease that is responsive to HIV Tx

48
Q

How is undifferentiated spondyloarhtiris characterized?

A

Sx of reactive arthritis or psoriatic arthritis in patients w/o full disease clinically

49
Q

Avascular necrosis of bone is associated with HIV how?

A

HAART regimen causing pain on weight bearing activities

50
Q

HIV and hypertrophic pulmonary osteoarthropathy

A

affects bones, joint and soft tissues and develops in HIV infected patients WITH PNEUMOCYSTIS JIROVECI PNEUMONIA

51
Q

Osteopenia and osteoporosis associated with HIV

A

3x more common regardless of therapy

52
Q

What are the 4 HIV associated muscle diseases?

A

1) Myalgia, fibromyalgia
2) noninflammatory necrotizing myopathy and HIV related wasting syndrome (cachexia)
3) Nemaline myopathy (Z band disruption in type I)
4) HIV associated polymyositis (lower CPK levels in HIV)

53
Q

What musculoskeletal features are associated with diffuse infiltrative lymphocytosis syndrome (salivary gland enlargement and peripheral CD8 lymphoctosis)?

A

peripheral arthritis

polymyositis

54
Q

What are is associated with HIV associated musculoskeletal infections?

A 
pyomyositis;
bacterial arthritis/osteomyelitis;
musculoskeletal TB;
atypical mycobacterial infection;
fungal infections
parasitic infections
55
Q

What are the rheum complications of HIV treatment?

A

Myopathy;
osteonecrosis and parotid lipomatosis;
adhesive capsulitis, Dupuytren’s, tenosynovitis, TMJ dysfxn

56
Q

How does viral arthritis present?

A

acute, symmetric polyarthritis that is typically assoicated with a rash

57
Q

What is the most common viral arthritis agent in US?

A

parvo B19 => subtle/absent rash in adults

58
Q

What Sx may occur after a rubella vaccination?

A

arthralgia, arthritis, neuropathic pain

59
Q

What types of viruses are associated with mosquitos? what do they cause?

A

Alphaviruses that cause arthritis and rash

60
Q

What does Hep B virus infection present as?

A

arthritis-urticaria syndrome

61
Q

How will Hep C virus infection present?

A

Cryoglobulinemic vasculitis presenting as palpable purpura of lower legs

62
Q

T/F viral modifications may contribute to autoimmunity

A

true => regulate cellular gene expression

63
Q

How do viruses affect the synovium?

A

immune response targets antigens on cell surface targeting that cell for destruction and alter cell cell interactions leading to Ab response to generate immune complexes at site of infection or systemically

64
Q

What is a characteristic and most useful Dx test of joint symptoms and rash with parvo B19?

A

serum anti-B19 IgM Ab;

failure to develop IgG Abs causing chronic B19 arthropathy

65
Q

Rubivirus or alphavirus patients will have joint Sx when? How to diagnose?

A

in women, 1 week before or after a rash with symmetric or migratory arthralgias common in synovitis

Diagnose: anti-IgG Ab seroconversion requires paired acute and convalescent sera

66
Q

Describe joint involvement with HBV

A

sudden in onset and severe with symmetric and simultaneous involvement of several joints;
may be migratory/additive

67
Q

At onset of arthritis from HBV, what is present in blood tests?

A

peak levels of serum Hep B surface antigen;
anti-hep B core antigen IgM antibodies;
soluble immune complexes that lead to immune complex-mediated arthritis with deposition in synovium

68
Q

Acute HCV infections presents how?

A

acute onset polyarthritis in rheumatoid distribution and associated with type II and III cryoglobulinemia

69
Q

What is the triad associated with essential mixed cryoglobulinemia?

A

arthritis, palpable purpura and cryoglobulinemia

70
Q

Define acute rheumatic fever

A

delayed, nonsuppurative sequel of a pharyngeal infection with group A strept causing polyarthritis that progressively goes through joints presenting 2-3 weeks after initial pharyngitis

71
Q

What 3 Ab titers are elevated in acute rheumatic fever?

A

streptolysin O;
hyaluronidase;
streptokinase

72
Q

What is the most important virulence factor of group A strept in musculoskeletal manifestations?

A

M protein due to similar homology of tropomyosin and myosin

73
Q

What are the major manifestations of acute rheumatic fever?

A 
polyarthritis;
chorea;
subQ nodules;
erythema marginatum;
carditis

MSK/Rheum path (22 decks)

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