Investigating the inflamed joint Flashcards
What is the difference in history for mechanical and inflammatory joints?
Worse with rest
Better with use= Inflammatory
Other way round- mechanical
What are inflammatory markers for joint pain?
PV- plasma viscosity
CRP- C reactive protein
ESR- Erythrocyte sedimentation rate
What happens to the body when there is an inflammation?
In inflammation there is increased production of antibodies by B cells, increased cytokine production by other white cells (locally or systemically) and increased protein
production by the liver
What is plasma viscosity
measure of how much protein there is in the serum
What is C reactive protein
an acute phase response produced by the liver
How is ESR measured?
- it takes longer for cells to settle in inflammation
What does high neutophils with inflammation usually mean?
Bacterial infection
What does high eosinophils with inflammation usually mean?
Parasites
Low lymphocytes common in what ?
SLE- lupus
Viral infections
What is main cause of normocytic anaemia in inflammation?
anaemia of chronic disease
What is the main cause of microcytic anaemia?
Iron deficiency anaemia
Why is rheumatoid arthritis associated iron deficiency
Non-steroidal anti-inflammatories used for pain relief of RA
They cause iron deficiency anaemia
What drugs cause iron deficiency anaemia?
NSAID’s
Non-steroidal anti-inflammatories
What is the main cause of macrocytic anaemia?
B12 and folate deficiency
Alcohol
Thyroid problems
What is the main cause of folate deficiency
Methotrexate- dihydrofolate reductase inhibitor
What are common causes of hyperuricaemia?
Diuretic medications
Increasing age
Diet
What are kidney function tests?
GFR
What are liver function tests?
ALP ALT Bilirubin Albumin
What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Osteoarthritis?
Normal
Normal
Normal
Normal
What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Rheumatoid arthritis or psoriatic?
Somewhat Raised 30-70
Somewhat Raised 12-13
Low
Raised
What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of SLE?
Somewhat Raised 30-70
Low
Low
Raised
What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Gout?
Raised- 200
Raised-15-16
Low
Raised
What is the levels of (CRP,PV, ESR), WCC, Hb, Plt of Infection?
Raised- 400
Raised-20-25
Low
Raised
What does transparent yellow synovial fluid mean
Non-inflammatory
What does pale yellow translucent synovial fluid mean?
inflammatory
What does yellow with red bits or green synovial fluid mean?
Septic
What does red synovial fluid mean?
Haemorrhage
What is the viscosity of synovial fluid?
Consistency of egg-white
What is the viscosity of inflammatory synovial fluid?
Consistency of water
What is the protein content and glucose uric acid levels of inflammation of synovial fluid?
Higher protein
Lower glucose
Uric acid higher in gout
What is the most common gram positive cocci?
Staphylococcus aureus
What is the most common gram negative cocci?
Neisseria gonorrhoeae
What shape are crystals in synovial fluid if someone with gout?
Needle shaped
What shape are crystals in synovial fluid if someone with pseudogout?
Brick shaped
What is the diagnosis of finding crystals in synovial fluid shaped as needle?
gout
What is the diagnosis of finding crystals in synovial fluid shaped as brick?
pseudogout
Is it + or - birefringence of gout crystals in synovial fluid?
Negative
Is it + or - birefringence of pseudogout crystals in synovial fluid?
Positive
What has + birefringence of the crystals in synovial fluid?
Pseudogout
What has - birefringence of the crystals in synovial fluid?
Gout
What is haemarthrosis?
Bleeding into a joint
Causes of haemarthrosis
Trauma
- injury - sports, RTC
- postoperative
- ‘traumatic’ arthrocentesis procedure (not blood, to start, but becomes bloody during the procedure)
- Bleeding disorders e.g haemophilia, excess warfarin use and minor trauma
- Vascular disorders
- Tumours
