Other types of arthritis

Question 1

Septic arthritis

• Cause
• Symptoms
• Investigations
• Treatment

Answer 1

-Usually caused by staph aureus or gonorrhoea
-Most commonly in the knee- acutely swollen, warm, painful.
-Synovial sampling and blood cultures, and imaging
-Treat with flucloxacillin/clindamycin for 6-12 weeks.
Needle aspiration to decompress.

Question 2

Reactive arthritis

• Cause
• Symptoms
• Treatment

Answer 2

• HLAB27 associated seronegative spondyloarthropathy
• Urethritis, conjunctivitis and arthritis following illness or post STI
• Can’t see, pee or climb a tree

-Give analgesia, NSAIDs, steroids.
-Methotrexate or sulfasalazine for persistent disease
Rarely lasts > 12 months

Question 3

Ankylosing spondylitis - cause

Answer 3

HLA B27 associated spondyloarthropathy.

Question 4

Ankylosing spondylitis - symptoms and signs

Answer 4

Men 20-30 yrs, lower back pain of insidious onset, stiffness, worse in the morning, better on exercise. Night pain.
Reduced lateral flexion, forward flexion and chest expansion.

Question 5

Ankylosing spondylitis - tests

Answer 5

Raised CRP and ESR
HLA B27 +ve in 90% of cases
XR- sacroiliitis, squaring of the vertebrae, bamboo spine
CXR- apical fibrosis

Question 6

Ankylosing spondylitis - management

Answer 6

Exercise- swimming
NSAIDs
Physiotherapy
DMARD if peripheral joints involved

1/3 of patients develop acute iritis- treat with TNF alpha blocker such as infliximab and etanercept