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Week A11 - MSK > Septic Arthritis, Crystal Arthritis & Reactive Arthritis > Flashcards

Septic Arthritis, Crystal Arthritis & Reactive Arthritis Flashcards

1
Q

What are the typical signs & symptoms of acute monoarthritis and what is the predicted cause (until proven otherwise)? [8]

A
  1. Typical features of inflammation
    • redness
    • heat
    • pain
    • swelling
  2. +/- Fever
  3. +/- Leukocytosis
  4. raised CRP

ACUTE MONOARTHRITIS IS SEPTIC UNTIL PROVEN OTHERWISE

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2
Q

What are the risk factors for septic arthritis? [7]

A
  1. Previous arthritis
  2. Trauma
  3. Diabetes Mellitus
  4. Immunosuppression
  5. Bacteremia
  6. Sickle cell anemia
  7. Prosthetic joint
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3
Q

Describe the pathogenesis of septic arthritis and how does it spread? [4]

A
  1. Bacteria enter joint and deposit in synovial lining
    • Haematogenous spread
    • Local invasion/Inoculation
  2. Rapid entry into synovial fluid due to a lack of a basement membrane and close relationship to blood vessels
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4
Q

Which joint is most commonly affected by septic arthritis? [1]

A

Knee joint

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5
Q

What 4 joints tend to get affected in polyarticular septic arthritis? [4]

A
  1. knee,
  2. elbow,
  3. shoulder
  4. hip
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6
Q

What are the risk factors of polyarticular septic arthritis? [2]

A
  1. over 60yrs
  2. rheumatoid arthritis
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7
Q

What investigations would you carry out on a patient with suspected polyarticular septic arthritis? [2]

A
  1. blood culture
  2. synovial fluid culture
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8
Q

What are the common microbiological causes of polyarticular septic arthritis? [2]

A
  1. streptococcus
  2. staphylococcus
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9
Q

What are the management options for septic arthritis? [3]

A
  1. Joint aspiration
    • daily or more frequently as needed
  2. Antibiotic therapy
    • based on gram stain/culture and clinical factors
    • duration is variable and depends on organism and host factors
  3. Surgical intervention
    • only necessary if patient is not responding after 48hrs of appropriate therapy
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10
Q

What is crystal arthritis? [2]

A
  • Gout = excess uric acid deposited as crystals in joints/soft tissue (uric acid in the joints/tissue is called tophi)
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11
Q

What are the risk factors for crystal arthritis?

  1. non-modifiable risk factors? [5]
  2. modifiable risk factors? [5]
A
  1. Non-modifiable
    • age
    • male gender
    • race
    • genetic factors
    • impaired renal function
  2. Modifiable
    • obesity
    • alcohol consumption
    • high-purine diet
    • HFCS
    • certain medications
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12
Q

What medications can trigger gout? [5]

A
  1. Aspirin
    • Bimodal effect
    • 75mg reduces UA excretion by approx. 15%
  2. Diuretics
  3. Cyclosporin
  4. Pyrazinamide & Ethambutol
  5. Nicotinic acid
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13
Q

What are the differential diagnoses for crystal arthritis? [2]

A
  1. Septic Arthritis
    • always have to consider with an acute mono-arthritis
  2. CPPD (Pseudogout)
    • less commonly 1st MTP
    • most commonly seen in:
      • knee,
      • wrist,
      • shoulder
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14
Q

What are the management goals for crystal arthritis?

  1. acute attacks? [2]
  2. long term? [3]
A
  1. Acute attacks: Relieve pain and reduce inflammation
    • Non-pharmacological (cold packs)
    • NSAIDs/COX-2 inhibitors/Colchicine/Corticosteroids
  2. Long-term
    • Prevent further acute attacks (62% within 1yr)
    • Prevent joint damage
    • Eliminate tophi
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15
Q

What lifestyle modifications are recommended for people with crystal arthritis? [6]

A
  1. Reduce purine intake
  2. Reduce fructose-containing drinks
  3. Include skimmed milk, low fat yoghurt, vegetable protein and cherries every day
  4. Weight loss
    • 1 kg/month (avoid crash diets)
    • avoid high protein diets
  5. Moderate exercise
  6. Reduce alcohol
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16
Q

What drugs are urate lowering therapies used for crystal arthritis? [2]

A
  1. Allopurinol
    • Start at 100mg increase in 100mg steps every 4 weeks until target or max 900mg daily
  2. Febuxostat
    • 80mg with option to increase to 120mg after 4 weeks if not at target urate
17
Q

What is reactive arthritis? [2]

A
  1. seronegative (for rheumatoid factor) spondyloarthropathies
  2. develops after an infection occurs elsewhere in the body
18
Q

What are the risk factors for reactive arthritis? [2]

A
  1. Strong association with HLA-B27
  2. More common in males
19
Q

List the organisms that cause reactive arthritis under the following headings:

  1. enteric infections? [5]
  2. GU infections? [5]
A
  1. Enteric Infections:
    • Salmonella
    • Shigella
    • Yersinia
    • Campylobacter
    • Clostridium
  2. GU Infections
    • Chlamydia
    • Trachomatis
    • Neisseria Gonorrhoeae
    • Mycoplasma Genitalium
    • Ureplasma Urealyticum
20
Q

What is the typical clinical presentation of reactive arthritis? [11]

A
  1. Acute onset usually 2-6 weeks post infection
  2. Warm, swollen, tender joints, usually lower limb.
  3. Systemically unwell
    • elevated inflammatory markers
    • malaise
  4. Triad of Arthritis, Conjunctivitis & Urethritis may occur
21
Q

What are the typical features of reactive arthritis in joints? [4]

A
  1. Lower limb asymmetric oligoarthritis
  2. Dactylitis (sausage digits)
  3. Enthesopathy (Achilles tendonitis, plantar fasciitis)
  4. Inflammatory back pain
22
Q

What investigations should be done on a patient with suspected reactive arthritis? [6]

A
  1. Joint Aspiration to exclude sepsis
  2. Swabs — urethral/cervical
  3. Screen for other related infections
  4. Inflammatory markers ESR & CRP
  5. Chlamydia serology
  6. HLA-B27 for prognostic not diagnostic reasons
23
Q

What are the management options for reactive arthritis?

  1. mild? [2]
  2. moderate? [3]
  3. severe/prolonged? [1]
A
  1. Mild
    • NSAIDs
    • simple analgesia
  2. Moderate
    • NSAIDs
    • joint aspiration
    • corticosteroid injection
  3. Severe or Prolonged
    • Consider DMARD

Week A11 - MSK (13 decks)

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