Joint Pain Flashcards
Substances that can exacerbate gout
large meal with purines (red meat, liver, nuts, seafood)
increase in alcohol consumption
THIAZIDE diuertics, loop diuretics
chemotherapeutic agents
How to diagnose goat
joint aspirate!
polarizing microscopy of fluid must reveal monosodiumurate (MSU) crystals that have strong NEGATIVE BIREFRINGENCE
Difference between gout and septic joint
WBC in aspirate is normal value for gout, but elevated in septic joint (avg 100,000) with 90% neutrophil dominance
gouty arthritis
excess uric acid which leads to crystal deposition in joints
Difference between gout and PSEUDOgoat
gout - MSU crystals that have negative birefringence
pseudogout - calcium pyrophosphate dehydrate CPPD crystals that are POSITIVE berefringence
Ddx to consider for nontraumatic swollen joint
gout, (or any crystal induced arthritis), infectious arthritis, osteoarthritis, rheumatoid arthritis
Typical first episode of gout
swelling and pain, usually of one joint, accompanied by erythema and warmth…can be easily confused with cellulitis
Classically, a gout attack usually involves _______ joint of ______ toe called _______
metatarsophalangeal joint of first toe, called podagra
T/F: Uric acid level is always elevated during a gout attack
FALSE. may be normal/low
Radiographic changes in the joint can show
cystic changes in the joint surface, punched out lesions and soft-tissue calcifications (non specific)
An infection usually involves __#___ joint(s) if bacterial in origin
1
What kinds of organisms can invade joints?
bacteria (i.e. gonoccal infections), fungi, mycobacteria
3 ways microbes can inject joints
- direct penetration (surgery, bite, trauma)
- hematogenous spread from distant infection
- extension from nearby infected joint
How to evaluate joint suspicious for infection
- arthrocentesis and examination of synovial fluid
- blood culture, Gram stain and culture
- CBC, ESR
Risk factors for infectious arthritis
alcoholism, DM, HIV, malignancy, hemodialysis (HD), IV drugs, chronic med conditions
ROM for septic joint
VERY LIMITED due to pain; will also have joint effusion and fever
Typical presentation of osteoarthritis
Elderly, obese (>65) dull, deep, achey pain.
gradual onset, made worse with activity and better with rest; pain constant in later stages
What can be felt on physical exam for osteoarthritis
crepitus with passive ROM
How do xrays look for osteoarthritis
initially NORMAL then slowly gets bone sclerosis, subchondral cysts, and OSTEOPHYTES (not present in RA)
Which joints does RA typically affect most commonly
joints of hands (PIP, MCP) and wrists!!!
also can affect any other joints
Symptoms of RA
- MORNING STIFFNESS, improves as day progresses
- fever, fatigue
- C1-C2 subluxation
- subcutaneous rheumatoid nodules over extensor surfaces (PATHGNMONIC)
Abnormal labs in RA
- positive rheumatoid factor RF, positive anti-CCP
- elevated ESR and CRP
- anemia
- thrombocytosis and low albumin
RA affects which part of the joint
the synovium (synovitis)
Acute treatment of gout attack
colchicines, NSAIDS, and glucocorticoids, ice packs
Maintenance therapy for gout
allopurinol (decreases uric acid production)
probenecid (increases excretion of uric acid)
Treatment for septic arthritis
IV antibiotics and surgery for drainage of infected joint (usu vanc, but do culture to know what you’re dealing with)
First line agent for RA treatment
DMARD (disease modifying antirheumatic drugs)
METHOTREXATE AND SULFASALZINE
When to do surgery for joint disease
last resort when medication and physical therapy fail
What can be used as adjunct to DMARD for RA
NSAIDS, short term corticosteroids, topical analgesics, physical/occupational therapy, mobility exercises, weight loss
ACR/EULAR criteria for dx of RA
- joint involvement
- positive serology (CCP/RF elevated)
- positive acute phase reactants (elevated CRP and ESR)
- duration of symptoms > 6 weeks
