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Lectures Flashcards

1
Q

What percent of acutely swollen/painful joints are down to septic arthritis?

A

10%

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2
Q

What percentage of those with septic arthritis will develop permanent damage?

A

50%

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3
Q

What is the mortality of septic arthritis?

A

10-16%

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4
Q

What are the four hallmarks of septic arthritis?

A

Biofilm - protecting the microbe
Acute synovitis with proliferative hyperplasia
Cartilage degradation by bacterial and leucocyte proteases/cytokines/pressure phenomenon
Subchondral bone loss

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5
Q

What are the three ways in which septic arthritis may develop?

A

Haematogenous (50%)
Direct - osteomyelitis
Implantation - trauma, arthrocentesis, intra-articular injection and orthopaedic surgery

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6
Q

What are the main causative agents of septic arthritis in infants?

A

G -ve bacilli

H. Influenzae

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7
Q

What are the main causative agents of septic arthritis in children?

A

S. Aureus

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8
Q

What are the main causative agents of septic arthritis in adults?

A

S. Aureus

Group A β-haemolytic streptococci

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9
Q

What are the main causative agents of septic arthritis in the elderly?

A

G -ve bacilli

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10
Q

What are the main causative agents of septic arthritis in those with a prosthetic joint?

A

Early - coagulase negative staph

Late - staph and strep

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11
Q

What percentage of TB infections lead to TB mono arthritis?

A

1% of TB infections cause/lead to TB monoarthritis

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12
Q

How might you diagnose a TB monoarthritis?

A

Positive skin test - evidence for
Abnormal CXR - evidence for
Synovial biopsy and culture - diagnosis

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13
Q

Which joints may be affected by a tuberculous monoarthritis?

A

Weight bearing joints - knee/hip/wrist

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14
Q

What is the patient profile of a gonococcal arthritis?

A

Young
Sexually active
Female

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15
Q

What is the initial presentation of a gonococcal arthritis?

A

Migratory polyarthralgia
Tenosynovitis
Dermatitis

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16
Q

What percentage of gonococcal infection arthritis are polyarticular?

A

40-70% of gonococcal bacterial arthritis cases are polyarticular

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17
Q

What is is the percentage recovery of bacteria in a gonococcal arthritis?

A

<10% blood

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18
Q

What is the response of a gonococcal arthritis to antibiotics?

A

Within a few days there is an excellent outcome

19
Q

What is the patient profile for a non-gonoccal bacterial arthritis?

A

Newborn/elderly
Compromised host
RA host

20
Q

What is the initial presentation of a non-gonococcal bacterial arthritis?

A

Single, hot, swollen and painful joint

21
Q

What percentage of non-bacterial gonococcal arthritis are polyarticular?

A

10-20%

22
Q

What percentage of bacterial recovery is found in non-gonococcal bacterial arthritis?

A

> 90% synovial fluid

50% blood

23
Q

What response does non-gonococcal bacterial arthritis have to antibiotics?

A

Takes weeks
Joint drainage must be adequate
Outcome often poor

24
Q

What are the steps of managing septic arthritis?

A 
Immediate synovial fluid aspiration
Blood culture
Swab and culture nasopharynx/rectum
GU culture
Imaging
25
Q

What tests are performed on the fluid aspiration of septic arthritis?

A

Gram stain - 50% NGSA and 25% GSA
Culture - 90% for NGSA and 50% for GSA
PCR for gonococcal DNA

26
Q

What will you see on each modality of imaging used in septic arthritis?

A

XR - effusion, juxta-articular osteoporosis and erosion

CT - effusion; use diagnostically for hip/shoulder aspiration

MRI - Soft tissue oedema and abscesses

27
Q

How do you manage septic arthritis?

A

ABx against staph/strep - pen or fluclox (modified based on culture and serology)

IV ABx for 2-4wks

Join drainage - FNA or open

Early joint mobilisation to prevent contractors

Removal of any prosthetic

28
Q

How would you summarise septic arthritis?

A

An acute rheumatological emergency characterised by a single, hot, swollen joint.

Must be immediately aspirated for gram stain and culture.

Treat with ABx, drain and mobilisation.

29
Q

What is a DDx for septic arthritis?

A

Flare up of systemic joint disease

Gout/pseudogout

Seronegative arthritis (reactive/psoriatic/IBD arthritis)

Sarcoidosis

Vasculitis

30
Q

What is the cause of gout?

A

An inflammatory response to monosodium urate monohydrate crystals developing into secondary hyperuricaemia

31
Q

What is the epidemiology of gout?

A

Prevalence 8.4/1000
8x M>F
Rare in children and pre-menopausal women

32
Q

What is the typical age of onset of gout?

A

40-50y in men

>60 women

33
Q

How do you define (quantitatively) hyperuricaemia?

A

> 6mg/dl or >360umol/l

34
Q

What is the relationship between RA and gout?

A

Inverse

35
Q

How can hyperuricaemia be classified?

A

Underexcretion - 90%

Overproduction - 10%

36
Q

What are the many many causes of hyperuricaemia?

A 
Idiopathic/genetic
Chronic renal failure
Drugs and cytotoxic drugs
Blood causes
Psoriasis
37
Q

What drugs are known to cause hyperuricaemia?

A

CANT LEAP

Cyclosporin/cytotoxic (tumour lysis syndrome)
Alcohol
Nicotinic acid
Thiazides
Lasic
Ethambutol
Aspirin - low dose
Pyranzinamide
38
Q

Which blood disorders are known to cause hyperuricaemia?

A 
Polycythaemia
Leukaemia
Pernicious anaemia
Chronic haemolytic anaemia
Lymphoproliferative disorders
39
Q

Which joint is most commonly affected by an acute gouty episode?

A 
1st MTPJ (podagra) in 50%
Other lower limb joints
40
Q

Other than the lower limb joints where else might gout present itself?

A

Non-articular deposition in the olecranon bursa and achilles tendon

41
Q

Is gout generally mono or polyarticular?

A

Gout is monoarticular in 90% of cases

42
Q

When might gout progress to to a polyarticular pathology?

A

In females with a myelo/lymphoproliferative disorder

43
Q

What is the onset of gout?

A

Gout tends to have a rapid onset of pain, swelling and erythema

Rheumatoid (1 decks)

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