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Learn these Flashcards > Lecture 26: Monoarticular Syndromes, Hot Joints > Flashcards

Lecture 26: Monoarticular Syndromes, Hot Joints Flashcards

1
Q

What are the causes (differential diagnosis) of monoarticular or monoarthritis

A
  1. Infection (most serious)
  2. Crystals (Gout, CPPD) (most likely)
  3. Trauma/Overuse
  4. Tumor (lymphoma, metastasis)
  5. Autoimmune (RA/SLE)
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2
Q

How does acute gout present?

A
  1. Monoarticular:85-90%
  2. Involves 1st MTP (90%)
  3. Abrupt, nocturnal onset
  4. No constitutional symptoms
  5. Self-limiting (resolves)
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3
Q

Acute gout presentation (cont.)

A
  1. Can involve ankle, knee, wrist, fingers and elbow or prepatellar or olecranon bursa)
  2. Uric acid can be normal in 50%
  3. Potential triggers: Alcohol, trauma (following surgery), or diuretic use or change
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4
Q

What are the clinical stages of gout?

A
  1. Asymptomatic hyperuricemia for 10-20 years
  2. Recurrent attacks of acute gout (monosodium urate)
  3. Intercritical period
  4. Chronic tophaceous gout (MSU crystals in synovium)
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5
Q

How would one diagnose gout?

A
  1. Demonstrate needle shaped, intracellular, negatively birefringent (parallel yellow) crystals from synovial aspirate—–Review the slide
  2. Uric acid can be normal in 50% so can’t rely on it.
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6
Q

How would one treat acute gout?

A
  1. Colchicine (remember this for acute therapy)
  2. NSAIDs
  3. Steroids or
  4. Joint injection
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7
Q

What is the chronic urate lowering therapy and when do you give it?

A

Indicated only if one has

  1. 1 gout attack and chronic kidney disease as 70% of urate from purine metabolism gets excreted through urine
  2. Tophi
  3. 2 or more attacks per year
  4. H/O urolithiasis

Treatment
Xanthine oxidase inhibitor
Uricosuric (increase the renal excretion of uric acid)
Uricase (convert uric acid to allantoin)

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8
Q

CPPD (Calcium pyrophosphate deposit disease)

A
  1. Deposition of CPP crystals in articular cartilage, menisci, synovium or periarticular tissue)
  2. Associated with aging
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9
Q

Clinical presentations of CPPD

A
  1. Acute CPP: Previously called pseudogout
  2. Chronic: Polyarticular, symmetric, involving small joints of hands and feet
  3. OA with CPPD
  4. Asymptomatic
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10
Q

Characteristics of CPPD crystals?

A
  1. Weakly and positively birefringent
  2. Remember ABC; for aligned, Blue, and Calcium
  3. Rhomboid crystals
    (Gout were negative refringent, parallel yellow needles)
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11
Q

What are the characteristic radiologic features?

A 
Cartilage calcification (review slide)
No erosions, uniform joint space loss, osteophytes are variable)
Most common joints are knees and then hands and then symphysis
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12
Q

What is the treatment of acute CPP?

A

Similar to gout!

Rest, ice, steroids, NSAIDs, colchicine, steroid injection

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13
Q

Differences between gout and CPPD

A
  1. Gout: young, male, alcohol history, monoarticular, 1st MTP, several, self-limiting attacks, uric acid levels may be normal, joint aspiration-negative refringent, yellow needle-shaped crystals

CPPD: Elderly, symmetrical joint involvement (knee hands etc), crystals- positive refringent remember ABC. In the radiograph, look for calcium in the joint space that represents cartilage.

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14
Q

How would you diagnose septic arthritis?

A

Typically younger patient, monoarticular joint involvement, fever and systemic symptoms (chills pain, vomiting etc.)
Increase in white count, inflammatory markers
Knee most common site

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15
Q

Features of septic arthritis!

A
  1. Hematogenous spread to joints from systemic bacterial infection
  2. Staph aureus: Most common
  3. N Gonorrhea in young, sexually active.
  4. Pseudomonas in IV drug users
  5. Salmonella in sickle cell
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16
Q

Diagnosis and treatment of septic arthritis

A

Aspirate is positive in 100% (low viscosity, turbid, high WBC count, can have crystals-crystals don’t rule out infection) and send the fluid for culture and sensitivity. It is an emergency, if one does not aspirate joint, make a diagnosis, and start empiric parenteral antibiotics, the joint can be destroyed.

17
Q

Disseminated gonococcal infection

A

Young, sexually active, tenosynovitis, rash, migratory joint complaints

18
Q

Arthritis associated with malignancy

A
  1. Nocturnal pain
  2. Systemic features of weight loss, fatigue,
  3. Periosteal elevation and focal destructive lesion

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