infectious arthritis + crystalopathies Flashcards
common etiology of septic arthritis in native and prosthetic joints ?
s aureus
salmonella in septic arthritis happens when ?
in OM and w/ septic arthritis in sickle cell disease
triad w/ gonococal arthritis
- Migratory Polyarthralgia ( without purulent arthritis)
- Tenosynovitis
- Vesiculopustular skin lesions
other common syndrome with gono arthritis ? why is impt to recognize ?
purulent arthritis without skin lesion
long duration of antibiotics
tx gono arthritis
ctx
if think chlam or empirically : add doxy ( or azithro 1g)
lyme arthritis presents how
- late onset > 6M post infection
- oligoarthritis with synovitis
- swelling affecting mostly the knee
- swelling+ erythema without pain: sx fluctuate
how can we tx lyme athritis
doxy/amox x 28 days
if fail and have severe synoviti sā> ctx 2-4 weeks IV if everything else is excluded
gout : SF looks like what.
- needle shaped
- negatively birefringent
acute self limited inflamamtory arthritis
mono»_space; oligo»_space; poly
meds and foods that can cause high uric acid ?
- thiazide
- ASA
- allopurinol
- pyrazinamide
- beer, meat, seafood
why gout not common in woman
estrogen has protective effect
predilection of crystal arthritis ?
Monoarticular in ~80% of initial attacks with predilection to lower extremities, most commonly 1st MTP or knee
where to find tophi in crystal arthritis ?
helix and elbows
various crystal arthritis pseudogout presentation
- pseudogout : acute mono/oligo
- ra like : chronic inflam arthritis
- oa with cppd : atypical OA distribution ā> lateral knees, wrist and the elbows
SF in CPPD looks like what ?
rhomoboid shaped
positively birefringent
2nd causes of crystal arthritis
- hypothyroidism
- hypomg
- hypopo4
- wilsons ( rare)
- hemachromatosis ( 2nd, 3rd mcp arthritis with hooked osteophytes)
- hyperpara
other types of pseudogouts
- what ?
- who
- preesentationj
calcific tendinitis /milwaukee shoulder
- calcium phosphate hydroxyapatite crystals
- older female patients
- destructive shoulder arthropathy
Crowned dens syndrome ( CDS) . what is it and how dod you diagnosis
acute or subacute onset upper neck pain (usually with limited ROM)
elevated inflammatory markers and often fever
Diagnostic of CPPD if clinical/imaging features of CDS present
Gout tx ( acute)
- Nsaid
- colchicine
- glucocorticoid
- il1 blocker ( anakinra)
CrCl level to avoid colchicine regardless
if <10 or iuf on HD
who to give anakinra for gout
Consider only in patients with frequent flares and
contraindications to colchicine, NSAIDs & corticosteroids
why to avoid using allopurinol with AZA ?
risk of bone marrow failure
if have allopurrinol hypersensitivity, what to do ?
stop and never take again
definite inddications for urate lowering therapy
*> 2 attacks in last year
*Tophaceous gout
*Gouty Arthropathy (Erosions)
condition indications of gout tx : 1 epsodes acute gout+ rf . what are those rf ?
ckd stage 3+
uric acid level > 535
urolithiasis
what do you overlap urate lowering therapy with ? how long ?
anti inflamamtory prophylaxis ( colchicine/nsaid or low dose GC )
for 3-6 months
if have southeast asian or black patient and worried about hypersensivitiy syndrome with allopurinol, test for which gene ?
hla b 5801
feburxostat okay for dialysis patients ?
no
