MSK Swollen Painful Joints Teaching Flashcards
causes of a hot swollen joint
septic arthritis
crystal arthritis - gout/pseudo gout
OA
RA
reactive arthritis
psoriatic arthritis
trauma
hemarthrosis
what is septic arthritis
infection within the joint space
acutely destructive to the joint
can lead to osteomyelitis, sepsis and death
what causes septic arthritis
bacteraemia - skin infection, chest infection and STI
local spread - eg from osteomyelitis
direct inoculation - eg joint infection
which joints are normaly affected by septic arthritis
in order:
knee
hip
multiple
elbow
what are risk factors of septic arthritis
joint pathology - RA, OA
joint prothesis
joint injections
immunosuppression
alcoholism
diabetes
extremes of age
IV drug abuse
how does septic arthritis present
acute onset
sever pain, limiting any mobility
often single joint, hot, red, swollen
systemic: fever, rigors, sepsis
what are risk factors of gout
m>f
Fhx
alcohol excess
diuretics
renal impairment
metabolis syndrome
obesity
OA
which joints are most commonly affected by gout
commonly first attacks the firt MTPJ
can affect ankle, knees, elbow, wrist and smaller joints in the hand
describe the presentation of acute gout
single joint
red, hot swollen
rapid onset
very tender
may have visible tophi
can have fever
what is pseudo gout
calcium pyrophosphate deposition on cartilage
chondrocalcinosis / CPPD
typically affects the proximal joints, often the knee and wrist
very rare in under 50s
what would you expect to see with pseudogout in polarising microscopy
positive birefringement rhomboid shaped crystals
what is the management of septic arthritis
sepsis resuscitation
ABX - 2 weeks IV, 4 weeks PO
analgesia
operative irrigation and drainage of the joint
what is the management of gout
aim is to offer rapid relief of pain and inflammation
Acute: NSAID, Colchicine (decreasing swelling and lessens uric acid crystals), corticosteriods
long term: allopurinol (reduces production of uric acid), start after the attack. reduce uric acid intake
how is pseudogout managed
aspiration is important
ice packs
low dose colchicine
IM/ Oral steriods
