Joint Presentations ☺️

Question 1

Red flag conditions for joint pain/swelling

Answer 1

Septic arthritis => refer to A&E, aspiriation, culture ABx

• red, hot swollen painful single joint
• rapid onset
• v restricted movement
• out of proportion to presentation
• systematically unwell

Bone malignancy => 2ww

• B symptoms
• persistent non mechanical bone pain
• night/rest pain

Inflammatory arthritis => urgent rheumatology referral

• morning stiffness, lasts 30min+
• joint swelling, tender
• symmetrical, small joints affected
• Hx of psoriasis, IBD, uveitis, recent infection

Question 2

Other possible differentials

Answer 2

Gout/psuedogout - SIMILAR PRESENTATION TO septic
-rapid onset severe pain, swelling, tender
Gout -
-big toe/small joints
-tophi if chronic

Pseudogout
-knees

Polymyalgia rheumatica

• women, 50+
• 2wks of bilateral shoulder/hip pain => interferes with movement, sleep, pain
• shoulder => elbow radiation
• hip => knee radiation
• long lasting morning stiffness => difficulty rising from chair, turning in bed, raising arms
• muscle strength intact

Question 3

Risk factors for gout
Management of gout
-acute
-preventative

Answer 3

Alcohol, red meat, seafood, ACEi/thiazide/Bb use, Fhx

Treat - max dose NSAID, PPI
-if not colchicine
-if not steroids
Long term - allopurinol or feboxustat
-can be used with acute management

Question 4

Risk factors for psuedogout
Management of pseudogout
-acute
-preventative

Answer 4

Age
Joint trauma
FHx
High Ca, Fe
Low Mg
Hypothyroid, hyperPTH

Acute
FIRST LINE - NSAID + PPI
if not, colchicine
if not, CS

Preventative
-colchicine for frequent episodes

Question 5

Management of polymyalgia rheumatica

Answer 5

Prednisolone
-reduce dose slowly when symptoms controlled

Counselling

• don’t stop taking CS abruptly
• avoid close contact with contagious people especially if they don’t have immunity

Follow up

• assess for symptoms for GCA
• abrupt onset temporal headache
• temporal tenderness
• visual disturbance
• jaw or tongue claudication.