Mehlman reactive; UW post trauma arthritis/synovial fluid normal 03-07 (3) Flashcards
M. Reactive. CP?
Classically presents as triad of
1) urethritis or abdominal infection
2) polyarthritis
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).
M. Reactive. CP.
Classically presents as triad of
….
2) polyarthritis
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).
1) urethritis or abdominal infection
M. Reactive. CP.
Classically presents as triad of
1) urethritis or abdominal infection
…..
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).
2) polyarthritis
M. Reactive. CP.
Classically presents as triad of
1) urethritis or abdominal infection
2) polyarthritis
….
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).
M. cause of reactive?
CHLAMYDIA
gonoccus DOES NOT cause reactive on usmle
M. what viral can cause reactive?
Rubella
Hep B and C
also Yersinia
M. reactive part of what genetic alteration?
Part of HLA-B27 constellation (PAIR).
M. post-traumatic arthritis. CP?
sito nera lapuose, tik cia.
Pain in joint that can present soon, or many years after, injury, where other DDx are ruled out.
M. post-traumatic arthritis. case on 2CK.
case where it sounds like patellar tendonitis (i.e. 2 years of knee pain, first worsened with basketball, but then progresses to more constant pain), but then they go on to say that patient had fracture to proximal tibia 30 year ago and has varus deformity of the knee.
ANSWER - traumatic arthritis, not patella tendonitis.
the implication is that the etiology for patient’s arthritis is ultimately linked to the varus deformity from the prior injury
UW. Synovial fluid analysis.
Appearance in normal?
Clear
UW. Synovial fluid analysis.
WBC in normal?
<200
UW. Synovial fluid analysis.
PMNs in normal?
<25 proc.
UW. Synovial fluid analysis.
Appearance in non-inflammatory (eg OA)?
clear
UW. Synovial fluid analysis.
WBC in non-inflammatory (eg OA)?
200 - 2000
UW. Synovial fluid analysis.
PMNs in non-inflammatory (eg OA)?
25 proc.
UW. Synovial fluid analysis.
Appearance in inflammatory (crystals, RA)?
translucent or opaque
UW. Synovial fluid analysis.
WBCs in inflammatory (crystals, RA)?
2000 - 100 000
UW. Synovial fluid analysis.
PMNs in inflammatory (crystals, RA)?
Often >50 proc.
UW. Synovial fluid analysis.
Appearance septic joint?
Opaque
UW. Synovial fluid analysis.
WBCs septic joint?
50 k - 150k
UW. Synovial fluid analysis.
PMNs septic joint?
> 80 - 90 proc.
UW reactive arthritis table. Preceding infection?
Genitourinary: Chlamydia trachomatis
GI: salmonella, Shigella, Yersinia, Campylobacter, Clostridioides difficile.
UW reactive arthritis table. Genitourinary m/o?
Genitourinary: Chlamydia trachomatis
UW reactive arthritis table. GI m/os?
GI: salmonella, Shigella, Yersinia, Campylobacter, Clostridioides difficile.
UW reactive arthritis table. MSK CP?3
Asymetric oligoarthritis
Enthesitis
Dactylitis
UW reactive arthritis table. extraarticular symptoms. ocular?
conjuctivitis, anterior uveitis
UW reactive arthritis table.
extraarticular symptoms. genital?
urethritis, cervicitis, prostatitis
UW reactive arthritis table.
extraarticular symptoms. dermal?
keratoderma blennorrhagicum, circinate balanitis
UW reactive arthritis table.
extraarticular symptoms. GI?
oral ulcers
UW reactive arthritis table.
Dx? 3
CLinical
Elevated inflammatory markers: ESR, CRP
Synovial fluid: incr. WBC (2-4k), negative gram stain and culture
UW reactive arthritis Q. arthritis tx?
Usually self-limited (eg, resolving within 6 months), and treatment is largely supportive. Arthralgia usually improves NSAIDs.
UW reactive arthritis Q. balanitis tx?
If treatment for circinate balanitis is desired, low-potency topical corticosteroids (eg, 1% hydrocortisone) are often adequate.
UW reactive arthritis Q. what underlying condition?
the risk of reactive arthritis is increased in patients with HLA-B27
UW reactive arthritis Q. when manifests?
1-4 weeks following certain GU/GI infection
UW reactive arthritis table. Management. 2 drugs
First line: NSAIDs
sometimes antibiotics (chlamydia, non-self limiting GI infection)
UW reactive arthritis table. Management. If nsaids fail or contraindicated?
Intraarticular GK
Systemic GK
Disease-modifying antirheumatic drugs
UW reactive arthritis Q. first line Tx?
NSAIDS
UW reactive arthritis Q. why abs are not first line?
Activated lymphoid cells (from infection) migrates to joints and extraarticular sites = cause inflammation. So this infl. is not because of bacteria –> no need of abs.
abs may be indicated depending on the underlying infection
UW reactive arthritis Q. Clinical + arthrocenthesis –> suspected ReA. what additional studies needed to establish Dx?
no additional studies
primarily = clinical
also arthrocentesis allows to rule out other causes
buvo option HLA-B27 - in these patients is inc. risk for ReA, but is not necessary
