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Musculoskeletal Physiopathology > Infectious Joint Pathologies > Flashcards

Infectious Joint Pathologies Flashcards

1
Q

Is septic arthritis inflammatory?

A

Infectious and inflammatory

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1
Q

What patients are most likely to present with septic arthritis?

A

Immunocompromised children

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2
Q

By which methods do microorganisms get into a joint in the case of septic arthritis?

A
  • Hematogenous (pneumonia, soft tissue infection moves into synovium)
  • Direct (bone into joint)
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3
Q

What are some etiologies of septic arthritis?

A
  • S. aureus (most common)
  • H. influenza
  • Gonococcal infection in sexually active young adults
  • E. coli
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4
Q

How is septic arthritis differentiated from gout?

A

Gout has hyperuricemia and takes 7 years to see destruction
Septic arthritis develops within ten days (in extremities)
(need labs)

aspiration of septic arthritis will have pus (not crystals)

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5
Q

What are some common locations for septic arthritis?

A
  • Knee and hip (most common)
  • Hand (often due to human bite)
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6
Q

What is the cause of soft tissue swelling in septic arthritis?

A

Joint effusion distorts fat folds

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7
Q

What is the first confirmatory radiographic finding for septic arthritis?

A

Loss of subchondral white line

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8
Q

A patient comes in with soft tissue swelling around the knee, seemingly filled with pus. Upon radiographs of the knee, there is a loss of joint space, bone destruction, and a loss of subchondral white line. You ask your patient if they’ve had any recent infections and they report they had a staph infection about a week ago.
What is the likely diagnosis?

A

Septic arthritis

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10
Q

A patient comes in with an acutely red and swollen proximal interphalangeal joint of the second toe with pus exuding from it. The patient reports that this appeared within a matter of days and is aggravated when they step onto that foot. Upon history, they are a sexually active young adult who has contracted gonococcal infection recently.
What is the likely diagnosis?

A

Septic arthritis

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11
Q

Septic arthritis involves rapid loss of joint space and aggressive bone destruction.
What can happen to bones in a later stage of septic arthritis?

A

Bone ankylosis (fusion)

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12
Q

What are the ESR and CRP levels in a patient with septic arthritis?

A

Both increased

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13
Q

What are the alkaline phosphatase levels in a patient with septic arthritis?

A

Normal

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14
Q

Is someone with septic arthritis positive or negative for HLA-B27?
For RF?

A

Both negative

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15
Q

What may be found in a synovial biopsy of a joint affected by septic arthritis?

A
  • Normal uric acid (differentiates gout)
  • Pus
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16
Q

Along with antibiotics, what are some treatments for septic arthritis?

A
  • Aspiration to decompress the joint
  • Irrigation of the joint
  • Decrease motion and weight bearing
  • Joint ankylosis may mean joint replacement surgery
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17
Q

Is fungal arthritis inflammatory?

A

Infectious and inflammatory

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18
Q

How common is fungal arthritis?

A

Rare

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19
Q

Fungal arthritis is often a complication of ___

A

neoplastic disease or severely immunocompromised patients (ie HIV/AIDS)

20
Q

Fungal arthritis is frequently associated with involvement of which other organs?

A

Lungs

22
Q

What is one fungus that may cause fungal arthritis?

A

Candida species (yeast)

23
Q

Fungal arthritis in the spine presents similarly to ___

A

Pott’s disease (spinal tuberculosis)

24
Q

Fungal arthritis is ___ destructive

A

highly

25
Q

How is fungal arthritis treated?

A

Difficult: anti-fungal drugs are toxic to other tissues, especially the liver

26
Q

How is fungal arthritis diagnosed?

A

Diagnosis by biopsy
(cannot differentially diagnose radiographically from bacterial/septic arthritis)

27
Q

Is Lyme disease inflammatory?

A

Yes, it’s a parasitic infection that exhibits a chronic inflammatory response

28
Q

Lyme disease is an infection by what bacterium?

A

Spirochetes: borrelia burgdorferi

30
Q

Spirochete, borrelia burgdorferi, infection causes Lyme disease
What organism transmits this bacterium to humans?

A

Ixodes tick (in nymph stage) during May-July

31
Q

How common is Lyme disease?

A

15,000-20,000 cases annually in the US

32
Q

What ages are affected by Lyme disease?

A

Any age

33
Q

At what stage of Lyme disease are antibiotics most effective?

A

Stage 1

34
Q

Erythema chronicum migrans is a sensitive, non-specific indicator for which infectious joint pathology?

A

Bullseye rash: occurs 3-35 days after tick bite, indicates Lyme disease

35
Q

The following are symptoms of which stage of Lyme disease?

  • Fever
  • Fatigue
  • Malaise
  • Headache
  • Arthralgias
  • Lymphadenopathy
  • Cough
  • Meningeal irritation
  • Migratory myalgia
  • Testicular swelling
  • Brain fog
A

Stage 1 of Lyme disease

36
Q

The following are symptoms of which stage of Lyme disease?

  • Migratory musculoskeletal pain
  • Cardiac and neurologic abnormalities
  • Joint pain is migratory and transient
A

Stage 2 of Lyme disease

37
Q

The following are symptoms of which stage of Lyme disease?

  • Arthralgia
  • Severe arthritis
  • Swollen joints (especially the knee)
  • Skin abnormalities
  • Neurological abnormalities (paresthesia, encephalomyelitis, dementia)
A

Stage 3 of Lyme disease

38
Q

A patient is in stage 1 of Lyme disease
Which cells are involved in the chronic inflammatory response that is taking place?

A

Lymphocytes and plasma cells

40
Q

When does stage 2 of Lyme disease typically begin?

A

Weeks to months following lesion

41
Q

When does stage 3 of Lyme disease typically begin?

A

Months to year post-infection

42
Q

Over 50% of patients with Lyme disease have which two symptoms?

A

Arthralgia and severe arthritis

43
Q

What is the histology of stage 3 Lyme disease?

A

Affected joints are like rheumatoid arthritis:
Synovial membrane undergoes villous hypertrophy with mononuclear infiltrate

44
Q

At what point is Lyme disease permanent?

A

Stage 3 when neurologic effects begin (tingling/paresthesia, encephalomyelitis, dementia)

45
Q

If Lyme is suspected, what is used for diagnosis?

A

Antibody titers (IgM and IgG)

46
Q

Early treatment of Lyme disease uses higher doses of ___

A

tetracycline or erythromycin

47
Q

Later stages of Lyme disease require long-term, high doses of ___

A

antibiotic treatment

49
Q

If a patient tells you that they have recently been prescribed tetracycline or erythromycin in a high dose, what should you suspect?

A

Early stage of Lyme disease

Musculoskeletal Physiopathology (32 decks)

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