[Rheum] Monoarthropathy Flashcards

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1
Q

what is your dx of a hot, swollen joint with a reduced ROM until proven otherwise?

A

septic arthritis (SA)

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2
Q

when should you aspirate the joint?

A

before abx therapy

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3
Q

what is the joint aspirate sent for?

A

3Cs and G (cells, culture, crystals and gram stain)

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4
Q

what do you start while waiting for results?

A

empirical IV abx based on likely organism

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5
Q

what is the most common causative organism for SA?

A

staph aureus

however, in high risk groups, gram -ve abx cover must be given

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6
Q

who are at high risk of gram -ve organisms causing SA?

A
  • elderly
  • recurrent UTIs
  • recent abdominal surgery
  • previous gram -ve bacteraemia
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7
Q

what is unique about prosthetic joint infections?

A

a biofilm adheres to them

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8
Q

what are prosthetic joint infections defined as?

A
  • early (<3 months post surgery)

- delayed (>3 months post surgery)

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9
Q

what are delayed prosthetic joint infections more susceptible to?

A

coagulase -ve staphylococcus aureus

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10
Q

pt has a septic joint. what do you do next?

A

aspirate and send for 3Cs and G

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11
Q

pt has a septic joint and is sexually active. what else would you send for after joint aspiration?

A

gonococcal NAAT

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12
Q

after aspirating and sending off aspirate for 3Cs and G, what do you do next?

A

empirical IV abx and repeat joint aspiration until dry

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13
Q

there is bacterial growth on culture. what do you do next?

A

prescribe prolonged course of abx (local guidelines)

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14
Q

there is no bacterial growth on culture. what do you do next?

A

if purulent fluid (↑WCC) ⇒ re-aspirate joint

if non-purulent ⇒ consider other dx, stop abx

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15
Q

what is gout?

A

a crystal arthropathy where -ve birefringence MSU crystals are deposited in soft tissues e.g. joints

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16
Q

what are the risk factors for gout?

A
  • purine rich diet
  • obesity
  • high ETOH intake
  • DM
  • chemotherapy / malignancy
  • genetic defects of purine metabolism
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17
Q

how do you manage an acute attack of gout?

A

strong NSAID e.g. Naproxen until 1-2 days after the attack has settled + PPI gastric coverage

OR

colchicine for 5-7 days

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18
Q

how do you prevent another attack of gout: conservative mx?

A
  • reduce ETOH intake
  • lose weight
  • reduce processed purine-rich foods
19
Q

how do you prevent another attack of gout: medical mx?

A

urate lowering therapy (ULT):

  • 1st line: allopurinol
  • 2nd line: febuxostat
20
Q

what do you need to co-start with allopurinol and why?

A

co-start with colchicine

allopurinol can paradoxically trigger an acute flare

21
Q

urethritis, conjunctivitis and arthritis. dx?

A

reactive arthritis (can’t see, pee or climb a tree)

22
Q

asymmetric polyarthralgia, tenosynovitis and skin lesions. dx?

A

gonococcal arthritis

23
Q

HLA-B27 +ve. dx?

A

seronegative spondyloarthropathies

24
Q

what is the pathophysiology behind gout?

A

urate crystal deposition in joints

25
Q

what are the risk factors for gout?

A

obese, high ETOH and red meat consumption

26
Q

what does the fluid aspirate for gout show?

A
  • urate

- negatively birefringent needle shaped crystals

27
Q

what is the rx for gout?

A

acute: NSAIDs / colchicine
chronic: allopurinol / febuxostat

28
Q

what is the pathophysiology behind pseudogout?

A

calcium pyrophosphate (CPPD) deposition in joints

29
Q

what are the risk factors for pseudogout?

A
  • elderly
  • hypothyroid
  • hyperparathyroid
  • electrolyte deficiencies
  • haematochromatosis
30
Q

what does the fluid aspirate for pseudogout show?

A
  • calcium pyrophosphate
  • positively birefringent
  • rhomboid shaped crystals
31
Q

what is the rx for pseudogout?

A
  • NSAIDs / colchicine

- replace electrolytes if deficient

32
Q

what is the pathophysiology behind reactive arthritis?

A

unknown exact aetiology

likely CD4+ T-cell autoimmune reaction

33
Q

what are the risk factors for reactive arthritis?

A
  • recent STI
  • gastroenteritis
  • HLA-B27
34
Q

what does the fluid aspirate for reactive arthritis show?

A
  • straw coloured
  • WCC 2-100x10^9/L
  • negative culture
35
Q

what is the rx for reactive arthritis?

A
  • treat underlying infection
  • NSAIDs
  • may need steroids/DMARDs
36
Q

what is the pathophysiology behind haemarthrosis?

A

trauma, causing a haematoma in the joint

37
Q

what are the risk factors for haemarthrosis?

A
  • “recurrent fallers”
  • anticoagulation
  • post surgery
38
Q

what does the fluid aspirate for haemarthrosis show?

A

blood

39
Q

what is the rx for haemarthrosis?

A

correct coagulopathy

40
Q

what is the pathophysiology of septic arthritis?

A

infection in the joint

41
Q

what are the risk factors for septic arthritis?

A
  • immunocompromised
  • penetration injury
  • overlying ulcerated skin
42
Q

what does the fluid aspirate for septic arthritis show?

A
  • purulent (WCC >100x10^9/L)

- bacterial growth on cultures

43
Q

what is the rx for septic arthritis?

A
  • aspirate to dryness

- IV abx based on cultures