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Orthopaedics > Septic Arthritis, Crystal Arthritis and Reactive Arthritis > Flashcards

Septic Arthritis, Crystal Arthritis and Reactive Arthritis Flashcards

1
Q

What common categories can joint problems fall into?

A

Infection
Inflammatory arthropathy
Crystal arthropathy
Degenerative

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2
Q

What are the clinical signs of septic arthritis?

A

Pain
Fever
Swollen Joints
Loss of Function

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3
Q

Name the most common causative organisms of septic arthritis?

A

S.Aureus
Neisseria gonorrhoea
Haemophilus influenzae

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4
Q

Name some risk factors for septic arthritis.

A 
Person is on steroids
Rheumatoid arthritis 
High uric acid levels
- older people
- fat people
- high alcohol consumption
- high protein diet
- DM
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5
Q

Define septic arthtitis.

A

Bacterial infection of joint by blood spread or direct inoculation

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6
Q

Name 6 routes by which bacteria can reach the joint and cause septic arthritis.

A

1 - Haematogenous route
2 - Dissemination from osteomyelitis
3 - Spread from adjacent soft tissue infection
4 - Diagnostic or therapeutic measures
5 - Penetrating damage by puncture or trauma

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7
Q

What investigations should be done in suspected septic arthritis?

A

Joint aspirate - microbiology for gram stain and culture
Blood culture - checking for sepsis
FBC - raised WCC in infection
X-Ray - no value expect to rule out fractures

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8
Q

What pathological changes occur in the joint in septic arthritis?

A

The synovium is inflamed with a fibrous exudate and numerous neutrophil polymorphs
- fibrin and neutrophils form pus which then lines the joint capsule
Underlying cartilage gets disrupted (should be pale and smooth)
- becomes rough as a result of the fibrin deposition

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9
Q

What is a common secondary complication of septic arthritis?

A

Osteoarthritis

- severe loss of articular cartilage

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10
Q

How is septic arthritis treated?

A

IV antibiotics

- hip infections are always surgically cleared, as it is the only way to get an aspirate

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11
Q

Describe TB septic arthritis.

A
  • blood spread from foci elsewhere in the body
  • usually the spine (Potts disease), hip, knee and tubular bones of the hands
  • causes granulomatous inflammation within the joints
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12
Q

What other specific types of septic arthritis are there?

A

TB
Lyme disease - borrelia burgdoferi
Brucellosis
Syphilitic arthritis - congenital and acquired

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13
Q

Name the two crystal arthropathies.

A

Gout and pseudogout

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14
Q

How are crystal arthropathies caused?

A

High levels of uric acid
- which precipitate out of the blood and are depositied in joint spaces
Deposition of this urate crystals occur in joints of soft tissue (tophi)
The body has an inflammatory reaction to the crystals

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15
Q

Describe acute and chronic gout.

A

Acute - precipitation in joint stimulates the acute inflammatory process
Chronic - crystals in the joint space and the surrounding soft tissue (tophi formation)

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16
Q

What investigations should be done to confirm a diagnosis of gout?

A

Joint aspirate
- cytology (examined under polarised light)
Serum urate levels
U&Es

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17
Q

If gout is present, what do you expect to see on cytology of as aspirate?

A

Negatively birefringement
- turn blue when aligned across the direction of polarisation
Needle shaped crystals

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18
Q

What is primary gout?

A

Hyperuricaemia due to a genetic predisposition

  • e.g. Lesch-Nyhan syndrome
  • deficiency of the enzyme uricase means uric acid can’t be broken down into soluble components
19
Q

What is secondary gout?

A

High uric acid due to a myeloproliferative disorder (PCRV)

  • leukaemia treated by chemo
  • thiazides
  • chronic renal disease
20
Q

What is more common, primary or secondary gout?

A

Secondary

21
Q

What do the uric acid crystals look like in chronic gout?

A

Chalky white appearance of crystals in the sub cut tissues

22
Q

How is gout managed?

A

NSAIDs - high dose to reduce pain and swelling
- alternatives (colchicine and corticosteriods)
For repeat attacks
- allopurinol (a xanthine oxidase inhibitor)
- uricosuric agent (probenecid) - increases uric acid secretion in urine

23
Q

What are the crystals deposited in pseudogout made of?

A

Calcium pyrophosphate

24
Q

What is the distinctive feature when pseudogout affects the cartilage and extra-articular tissues?

A

Chondrocalcinosis

25
Q

Name some causes of secondary pseudogout.

A

Hyperparathyroidism

Haemochromatosis

26
Q

Describe the appearance of pseudogout crystals on polarised light cytology.

A

Positively birefringent
- appear yellow when aligned across the direction of polarisation
Rhomboid shaped crystals

27
Q

What is chondrocalcinosis?

A

Calcification of the surface of the articular cartilage

- thin white line can be seen on X-Ray

28
Q

How can pseudogout be managed?

A

Aspiration - reduces pain and swelling
NSAIDs
Colchicine

29
Q

What is reactive arthritis?

A

Sterile synovitis which occurs in response to another infection

30
Q

What are some of the trigger organisms for reactive arthritis?

A

Salmonella
Shigella
Yersinia
Chlamydia trachomatis

31
Q

What are the two most common illnesses that precede a reactive arthritis?

A

Urethritis or a diarrhoeal illness

32
Q

What gene is reactive arthritis most often associated with?

A

HLA B27

- found in 75% of reactive arthritis cases

33
Q

What are the clinical features of reactive arthritis?

A 
Acute, asymmetrical lower limb arthritis
More common in men
Enthesitis 
Sarcoiliitis
Spondylitis
Anterior uveitis 
Conjunctivitis
Keratoderma blenorrhagica
34
Q

How soon after infection does reactive arthritis occur?

A

Can occur days to weeks post infection

35
Q

Describe keratoderma blenorrhagica.

A

Keratinised, mucousy skin lesions commonly found on the palms and soles
- vesico-pustular waxy lesion with a yellow brown colour

36
Q

What is the management of reactive arthritis?

A

Treating the triggering infection doesn’t alter the course (self-limiting)
NSAIDs
Intra-articular steroids

37
Q

What is the prognosis for reactive arthritis?

A 
Self limiting - lasts up to 6 months 
May be chronic 
May be cardiac complications
- aortic regurgitation 
- aortitis 
- amyloidosis
38
Q

What is enteropathic arthritis.

A

Form of reactive synovitis seen in association with UC and Crohn’s disease
An asymmetrical lower limb arthritis
This is an autoimmune reaction - antibodies cross reacting with the synovium

39
Q

How is enteropathic arthritis treated?

A

NSAIDs

Treatment of the underlying bowel disease

40
Q

Where does primary osteoarthritis appear?

A

Multiple joints in the hands

41
Q

What are the precipitating causing of secondary osteoarthritis

A 
Fracture
Previous sepsis 
Rheumatoid arthritis 
Osteonecrosis 
CDH
Steroids
Chronic overuse 
Gout
Haemochromatosis 
Ochronosis 
Peripheral neuropathy
42
Q

What is osteoarthritis?

A

Degenerative joint disease
- commonest form of arthritis
- common the middle aged/elderly
Seen most in weight-bearing joints (hip and knee)

43
Q

Describe the pathology of osetoarthritis.

A

Disorder of the articular cartilage
- loss of cartilage
- friction/wear of exposed subchondral bone causes subcondrosclerosis
- reaction nodules of bone form osteophytes
- reduced joint space
Synovium becomes hyperplastic -> mild inflammation

Orthopaedics (13 decks)

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