Monoarthritis Flashcards
(19 cards)
Give some differentials for mono articular arthritis
Gout Pseudogout Septic arthritis Reactive arthritis Osteoarthritis Internal derangement (osteomyelitis, Ca bone)
How could you differentiate between gout and pseudogout?
Joint aspirate:
Gout - monosodium urate crystals, negatively birefringent under plane polarised light
Pseudogout - calcium pyrophosphate crystals, positively birefringent
History - ask about risk factors for gout
Site
What are the signs of septic arthritis?
Fever Swelling Severer tenderness Erythema Warmth Markedly restricted ROM Guarding
Who is at risk of septic arthritis?
Immunocompromised - steroids,diabetes etc
IVDU
Joint prosthesis
Penetrating trauma
What organisms usually cause septic arthritis in IVDUs?
S aureus
Pseudomonas
What is the good standard diagnostic test for septic arthritis?
Joint aspiration and culture of synovial fluid
What organisms may cause septic arthritis?
S aureus Strep Pseudomonas Gonococci TB
How would you manage septic arthritis?
Analgesia
NSAIDs
Antibiotics
Urgent orthopaedic referral for washout
What is the gold standard diagnostic test and result for gout?
Joint aspiration
Presence of negatively birefringent needle shaped crystals (monosodium urate)
Hw does gout usually present?
Acutely inflamed, painful red joint.
Usually first metatarsophalangeal joint
Gouty tophi on ears and tendon sheaths
How would you manage an acute attack of gout?
NSAIDs
Colchicine
Analgesia
What lifestyle advice would you give to someone with gout?
Dietary changes - avoid high purine foods
Less alcohol
Weight loss
Why is allopurinol contraindicated in acute gout?
Can make the acute attack worse
What medication is used to prevent further attacks of gout?
Allopurinol
What might you see on X-ray in a patient with Pseudogout?
Chondrocalcinosis
What might you see on X-ray in a patient with gout?
Punched out lesions
Sclerosis
Tophi
How would you manage Pseudogout?
Symptomatic treatment only
Ice packs Analgesia Joint aspiration to help pain NSAIDs Colchicine Intra articulate steroid injections Systemic steroids if severe
What are the ADRs of steroids?
Osteoporosis Myopathy Peptic ulcers disease Immunosuppression Glaucoma, cataracts Skin atrophy, easy bruising, delayed wound healing Diabetes Dyslipidaemia Weight gain and fat redistribution
how long after an acute attack of gout should you wait before giving allopurinol?
4-6 weeks
to prevent it precipitating another attack
