Reactive + Septic arthritis

Question 1

cause of reactive arthritis?

Answer 1

HLA B27 gene

Gastroenteritis or STIs= most common trigger

Chlamydia= usually reactive

Question 2

presemtation of reactive arthritis?

Answer 2

Typically one acute, warm, swollen + painful joint (KNEE)

‘Can’t see, pee or climb a tree’
-Bilateral conjunctivitis (non infective)
-Anterior uveitis
-Urethritis (non- gonococcal)
-Circinate balanitis (dermatitis of the head of the penis)

Question 3

investigations of Acute warm, swollen painful joint?

Answer 3

Synovial fluid sent to microscopy, culture and sensitivity testing for infection, and crystal examination

Can give abs during this time incase it’s septic

Question 4

management of reactive arthritis?

Answer 4

• Treat the triggering infection
• NSAIDs
• Steroids injection into the affected joint
• Systemic steroids may be required if multiple joints affected

Recurrent= DMARDs or anti-TNF

Most cases resolve within 6 months and do not recur

Question 5

what causes septic arthritis?

Answer 5

Staph aureus= most common

Sexually active young= Neisseria gonorrhoea

Streptococcus Pyogenes (most common of the group A streps)

Haemophilus influenza

E.Coli

Question 6

presentation of septic arthritis?

Answer 6

Red, hot, swollen joint

-stiffness and ROM
-systemic symptoms (fever, lethary, sepsis)

Question 7

management septic arthritis?

Answer 7

Empirical IV antibiotics- until sensitivities are known

Antibiotics for 4-6 weeks (initially IV and then oral):
* Flucloxacillin (if staph aureus)
* Clyndamycin (penicillin allergy)
* Vancomycin (MRSA suspected)

Neisseria gonorrhoea= ceftriaxoine

Question 8

management of psoriatic arthritis?

Answer 8

NSAIDs
Intra-articular corticosteroids
Failure to response/ severe= DMARDs

Question 9

findings on Xray of psoriatic arthritis?

Answer 9

-Periostitis
-Ankylosing (fixation or fusion)
-Osteolysis (destruction of bone)
-Dactylitis (inflammation of whole digit)
-Pencil in cup (central erosion on one side)

Question 10

what Xray finding suggests arthritis mutilans?

Answer 10

penicil in cup (central erosion at one side of the joint)

Question 11

what part of finer does psoriatic arthritis usually affect

Answer 11

DIP
-compared to RA that usually affects PIP

Question 12

hand changes- psoriatic arthritis

Answer 12

Oncholysis- splitting of the nial from bed
Dactylitis- inflammation of entire finger
Enthesitis- inflammation of the entheses
Nail pitting
PLaques

Question 13

what are the 5 recognised patterns of psoriatic arthritis

Answer 13

1. Assymetrical oligoarthritis (one sided 1-4 joints)
2. Symmetrical polyarthritis (>4 joints)
3. DIP predominent pattern
4. Spondylitis (involving axial skeleton)
5. Arthritis mutilans (osteolytic destruction of phalanges)

Question 14

what screeening tool has been created to check. for psoriatic arthritis?

Answer 14

PSORIASIS EPIDEMIOLOGY SCREENING TOOL (PEST)
* Way for screening for psoriatic arthritis in patients with psoriasis
* Involves questions about joint swelling, a history of arthritis + nail pitting