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Rakeem's MSK > infective arthiritis > Flashcards

infective arthiritis Flashcards

1
Q

what are the 2 types of infective arthritis?

A

septic arthritis
osteomyelitis

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2
Q

define infective arthritis

A

The infection of the bone (osteomyelitis) or synovial joint space (septic arthritis).

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3
Q

what causes septic arthritis

A

it is the direct infection of the synovial joint space by bacteria, viruses, or fungus.

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4
Q

how does a septic arthritis infection spread

A
  1. spread from adjacent soft tissues/joints
    or
  2. hematogenous infection that has travelled through the blood to the infection site
    or
  3. the result of direct infection due to trauma/surgery.
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5
Q

most common causative organisms for septic arthiritis

A
  • Staphylococcus aureus (esp. MRSA)
  • Streptococci
  • STI organisms (Neisseria gonorrhoeae)
  • H influenza (children)
  • E coli
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6
Q

most common age range of people affected by septic arthiritis

A

Most common in children under 4 years or older adults.

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7
Q

risk factors for septic arthritis

A
  • Pre-existing joint disease (OA or RA)
  • Joint prostheses
  • IVDU
  • Immunosuppression
  • Alcohol misuse
  • Diabetes
  • Intra-articular corticosteroid injection
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8
Q

signs and symptoms of septic arthirits

A
  • Intense joint pain
  • Swelling
  • Redness
  • Warmth of joint
  • Reduced range of motion
  • systemic symptoms (fever, lethargy, sepsis)
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9
Q

most common affected area of septic arthritis

A

knee or hip, usually only affects one knee

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10
Q

duration for onset of symptoms

A

less than 2 weeks

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11
Q

differential diagnosis for septic arthiritis

A
  • Transient sinovitis
  • perthes disease
  • slipped upper femoral epiphysis
  • juvenile idiopathic arthritis
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12
Q

investigations for septic arthiritis

A
  1. joint aspiration
  2. blood culture
  3. sexual health review
  4. X ray/MRI/ultrasound
  5. synovial fluid analysis
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13
Q

what does joint aspirate do

A

gram staining, crystal microscopy, MC+S.

Gram staining will come back quite quickly and can begin to guide treatment.

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14
Q

what would a blood culture of septic arthritis find

A

raised WCC
raised ESR+CRP

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15
Q

treatment of septic arthiritis

A
  1. Aspirate joint, Surgical drainage and washout of the joint to clear the infection in severe
  2. Empirical Abx e.g. flucloxacillin
  3. Pathogen-directed Abx (only after results from aspirate come back) continued for 3 to 6 weeks
  4. Analgesia - NSAIDS
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16
Q

what can you not give septic arthritis patients

A

methotrexate

17
Q

what to do if a septic arthritis patient is on steroids

A

double the prednisolone dose

18
Q

define osteomyelitis

A

Inflammatory condition of bone caused by infecting organism

19
Q

what are chronic infections of osteomyelitis the result of

A

Chronic infections are likely a result of multiple different microbes,

20
Q

what are acute infections of osteomyelitis the result of

A

acute infections are likely a result of a single organism.

21
Q

most common causative organism of osteomyelitis

A

staph aureus

22
Q

how is osteomyelitis spread

A
  1. local -due to direct contamination of the bone

or

  1. haematogenous - when a pathogen is carried through the blood and seeded in the bone
23
Q

does osteomyelitis affect children or adults more

A

children

24
Q

risk factors for osteomyelitis

A
  • Open fractures
  • Orthopaedic operations, particularly with prosthetic joints (1% of replacements)
  • Diabetes, particularly with diabetic foot ulcers
  • Peripheral arterial disease
  • IV drug use
  • Immunosuppression
  • Children → upper resp tract or varicella infection
  • sickle cell anaemia
25
Q

signs and symptoms of acute osteomyleitits

A
  • fever
  • dull, bony Pain
  • Swelling
  • Erythema.
26
Q

signs and symptoms of chronic osteomyelitis

A
  • persistent pain
  • Soft tissue damage
  • Continuous draining sinus tract/wound.
27
Q

investigations for osteomyelitits

A
  1. Bone marrow biopsy – DIAGNOSTIC
  2. Blood inflammatory markers (ESR + CRP)
  3. X-ray/MRI/CT
  4. Blood cultures
28
Q

treatment of osteomyelitis

A

Antibiotics (min. of 4 weeks, to upwards of 6 months) - flucloxacillin

Surgical debridement (surgical cleaning)

29
Q

differential diagnosis for osteomyelitis

A

charcot joint - damage to sensory nerves due to diabetic neuropathy

Rakeem's MSK (23 decks)

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