Rheum - MedEd - approach to joints Flashcards
Approach to joint pain: 2 main things to consider
Timing and Toxicity
Toxic and acute joint is:
Red, hot, swollen, painful, febrile, loss of function
Toxic and acute joint/loss of function - differential
Trauma, infection, crystals, reactive (gonorrhea in joint or in body)
Indolent and chronic joint - what is the first thing to consider
Inflammatory or not
Indolent and chronic joint - noninflammatory - differential
Osteoarthritis - obese, in dependent joints, not inflammatory, no fever, no ESR/CRP
Indolent and chronic joint - inflammatory - what to ask?
How many joints are involved?
Chronic, indolent, inflammatory joint - 1 joint - what to consider on differential
Usually the same as acute toxic joint
Chronic, indolent, inflammatory joint - multiple joints - differential
SLE, RA - seropositive
Seronegative spondyloathropathies
Other Connective Tissue Diseases - could cause inflammation of other organs
What to do for red, hot, swollen joint? Procedure
Arthrocentesis
Though may not always do in practice, i.e. in gout
Interpret arthrocentesis - what are the components looking for
Appearance WBC PMNs Gram stain, culture Crystals
Normal arthrocentesis
Normal: serous fluid, <200 WBC, 25% PMNs, no gram stain, no crystals
OA arthrocentesis
OA: (can be red, hot, swollen, though not supposed to be inflammatory) will see essentially a normal tap, serous, <2000 WBC, 25% polys
Inflammatory arthrocentesis
Inflammatory: cloudy fluid, >2000 but <50,000 WBCs, 50% polys, no gram stain or culture, might have crystal disease (gout or pseudogout)
Septic arthrocentesis
Septic: will pull out pus (opaque, white), >50,000 WBCs, culture positive, crystals negative, stain positive with staph, for gonorrhea will need nuclear acid amplification
Serology - lupus
ANA, ds-DNA, anti-histone Ab