MSK Flashcards
Differential for a toe hurting?
SEPTIC ARTHRITIS Gout Pseudogout Psoriatic Arthritis Rheumatoid Arthritis Osteoarthritis Reactive Arthritis Trauma
If septic arthritis has been ruled out do you need to do any investigations if you suspect gout?
Not routinely
What investigations could you do to confirm gout?
Joint aspiration
Serum uric acid
X-ray - normal unless disease addvanced
What causes gout?
Disorder of purine metabolism leading to build up of urate crystals in joints
What causes Hyperuricaemia in the majority of cases?
Impaired renal excretion of urate
Risk factors for gout
Male Age Obesity HTN Diuretics
What is the prognosis for an acute gout attack?
Acute attacks usually completely resolve within 1-2 weeks without treatment.
What 2 things would you want to screen for in a pt presenting with gout?
Renal disease
CVD
Management options in acute gout?
Self Care
Pharmacological intervention
Refer is not resolving or uncertain
What is the self care advice to someone with gout?
Rest and elevate the limb.
Avoid trauma to the affected joint.
Keep the joint exposed and in a cool environment.
Consider the use of an ice pack or bed-cage.
1st line pharmacological mgmt of gout?
NSAIDs at max dose for 1-2 days following acute attack
PPI to protect from above
What is 2nd line pharma intervention for gout?
Colchicine
What do you do about allopurinol or febuxostat during an acute attack of gout?
Keep taking as normal
Safety net with gout?
advise the person to return if symptoms get worse, or if there is no improvement after 1-2 days
What are the preventative drug options for gout?
allopurinol or febuxostat
When will a pt stop allopurinol or febuxostat for prevention of gout?
Usually life long
Pts may reach “cure” levels of uric acid after modifying lifestyle but this is usually after years
Key aspects of history for knee pain
Trauma
SOCRATES
Systemic symptoms
Recent infections
Red flags for septic arthritis
Redness, swelling, heat, and reduced movement of the knee, especially if:
Rapid onset.
Movement is severely restricted,
Only one joint is affected
Knee pain is severe or, in people with pre-existing joint disease out of proportion to the usual symptoms.
Difficulty weight bearing, particularly in children.
Fever is present (although the absence of fever does not exclude septic arthritis); the person is systematically unwell.
There are risk factors for infection
Red flags for malignancy in knee pain
Pain at rest/night
B symptoms
Unexplained bone pain
If someone had knee pain with the following symptoms, what would you suspect?
Osteoarthritis
When would you refer someone with knee pain?
Septic arthritis can’t be ruled out
Suspected fracture
Osteonecrosis
Suspected inflammatory arthritis
Red flags for inflammatory arthritis
Pain that is worse at rest or during periods of inactivity.
Joint swelling, tenderness, and warmth — giving a ‘boggy’ feel on palpation.
Stiffness in the morning and after inactivity that lasts more than 15-30 minutes
