Monoarticular arthritis Flashcards
3 causes of monoarticular arthritis
- gout
- CPPD (pseudogout)
- infectious arthritis
When should you do arthrocentesis (aspiration) in monoarticular arthritis?
Always for monoarticular arthritis!! provides rapid, crucial info for diagnosis.
key clinical features of infectious arthritis
red, hot joint
-monoarticular, severlyl limited range of motion, and the patient LOOKS SICK.
knee is most common site, 2nd = hip
-severely affected range of motion**key
-fever, elevated WBC and ESR.
-cloudy, watery synovial fluid (normally clear and viscous)
-rash, and migratory arthritis in gonococcal arthritis.
features of monoarthritis that suggest malignancy?
- night time pain
- fatigue
- wt loss
- x ray abnormalities (focal destructive lesion, periosteal elevation)
2 joints most likely to be affected by CPPD (pseudogout)
knees and hands/wrists
appearance of gout crystals in polarized light
parallel yellow=gout!!
- needle shaped
- intracellular
- negatively birefringent
appearance of CPPD (pseudogout) crystals in polarized light
ABC
- Aligned
- Blue
- Calcium
- weakly birefringent
- intracellular
gout is caused by what type of crystals?
monosodium urate - MSU - underlying factor is elevated uric acid
clinical presentation of gout
- abrupt onset (usually at night)
- often in the big toe
- no constitutional symptoms
- often resolves in one week, without Rx
- can involve erythema and desquamation
triggering events for gout
- surgery
- dietary / alcohol excess
- diuretic usage
therapy for gout
- colchicine
- NSAIDs
- steroids
-Xanthine Oxidase inhibitors/ urate lowering therapy - if severe disease
indications for urate lowering therapy for gout
- 1 gout attack and chronic kidney disease (CKD)
- 2 attacks/year
- presence of tophi
radiologic features of CPPD
-cartilage calcification (remember calcium shows up on X ray.)
treatment for acute CPP
similar to gout.
monoarthritis in a young, sexually active patient, with a rash. Likely diagnosis?
-N. gonorrhea (gonococcal) arthritis.
