Painful swollen joint

Question 1

Clinical features to assess for painful, swollen jont

Answer 1

• Onset
• Timeframe
• Precipitating factors - trauma, surgery?
• Exacerbating and relieving factors
• Level of pain - able to weight bear?
• Systemic symptoms
• GI or genitourinary symptoms (reactive arthiritis)
• Previous episodes
• PMH - gout, rheum disease
• DH - inc OTC

Question 2

Examining a hot painful swollen joint

Answer 2

• Look feel move
• Skin changes? - erythema, temp
• Compare to cotnralateral joint
• Focal tenderness
• Check for joint effusion
• Systemic signs - check obs

Question 3

Investigations for painful hot swollen joint

Answer 3

• Bloods - FBC, U&E, LFT, CRP, ESR and urate can be done
• Blood culture if systemically unwell?
• X-ray if trauma - #?
• Joint aspiration - check opacity, colour and for frank pus then send for MC&S and check WCC count

Question 4

Joint aspirate and condition

Answer 4

• Normal - clear, normal WCC and low neuts
• Non-inflam arthiritis - clear/straw coloured, moderate WCC low neuts
• Inflam arthiritis - clear/cloudy/yellow, high WCC, moderate neuts
• Septic - turbid, very high WCC, high neuts

Question 5

Differentials for hot swollen painful joint

Answer 5

• Septic arthiritis
• Gout or pseudogout - microscopy will rule this out
• RA
• Spondyloarthropaties (HLA B27 +ve) eg psoriatic arthirits
• Trauma

Question 6

Causative organisms for septic arthiritis

Answer 6

• Staphylococcus aureus

Question 7

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Management septic arthirtis

Answer 7

• Emperical abx
• Urgent surgical irrigation and washout
• If prosthetic joint - revision of surgery needed

Question 8

Complications from septic arthiritis

Answer 8

• Sepsis
• Irreversible articular cartilage damage

Question 9

Management of differentials of septic arthiritis

Answer 9

• Gout - colchicine and NSAIDs
• Pseudogout - manage cause and NSAIDs
• RA - NSAIDs for pain before DMARDs or biologics
• Trauma - RICE, conservative