Septic Arthritis, Crystal Arthritis & Reactive Arthritis Flashcards
What are the typical signs & symptoms of acute monoarthritis and what is the predicted cause (until proven otherwise)? [8]
- Typical features of inflammation
- redness
- heat
- pain
- swelling
- +/- Fever
- +/- Leukocytosis
- raised CRP
ACUTE MONOARTHRITIS IS SEPTIC UNTIL PROVEN OTHERWISE
What are the risk factors for septic arthritis? [7]
- Previous arthritis
- Trauma
- Diabetes Mellitus
- Immunosuppression
- Bacteremia
- Sickle cell anemia
- Prosthetic joint
Describe the pathogenesis of septic arthritis and how does it spread? [4]
- Bacteria enter joint and deposit in synovial lining
- Haematogenous spread
- Local invasion/Inoculation
- Rapid entry into synovial fluid due to a lack of a basement membrane and close relationship to blood vessels
Which joint is most commonly affected by septic arthritis? [1]
Knee joint
What 4 joints tend to get affected in polyarticular septic arthritis? [4]
- knee,
- elbow,
- shoulder
- hip
What are the risk factors of polyarticular septic arthritis? [2]
- over 60yrs
- rheumatoid arthritis
What investigations would you carry out on a patient with suspected polyarticular septic arthritis? [2]
- blood culture
- synovial fluid culture
What are the common microbiological causes of polyarticular septic arthritis? [2]
- streptococcus
- staphylococcus
What are the management options for septic arthritis? [3]
- Joint aspiration
- daily or more frequently as needed
- Antibiotic therapy
- based on gram stain/culture and clinical factors
- duration is variable and depends on organism and host factors
- Surgical intervention
- only necessary if patient is not responding after 48hrs of appropriate therapy
What is crystal arthritis? [2]
- Gout = excess uric acid deposited as crystals in joints/soft tissue (uric acid in the joints/tissue is called tophi)
What are the risk factors for crystal arthritis?
- non-modifiable risk factors? [5]
- modifiable risk factors? [5]
- Non-modifiable
- age
- male gender
- race
- genetic factors
- impaired renal function
- Modifiable
- obesity
- alcohol consumption
- high-purine diet
- HFCS
- certain medications
What medications can trigger gout? [5]
- Aspirin
- Bimodal effect
- 75mg reduces UA excretion by approx. 15%
- Diuretics
- Cyclosporin
- Pyrazinamide & Ethambutol
- Nicotinic acid
What are the differential diagnoses for crystal arthritis? [2]
-
Septic Arthritis
- always have to consider with an acute mono-arthritis
-
CPPD (Pseudogout)
- less commonly 1st MTP
- most commonly seen in:
- knee,
- wrist,
- shoulder
What are the management goals for crystal arthritis?
- acute attacks? [2]
- long term? [3]
-
Acute attacks: Relieve pain and reduce inflammation
- Non-pharmacological (cold packs)
- NSAIDs/COX-2 inhibitors/Colchicine/Corticosteroids
-
Long-term
- Prevent further acute attacks (62% within 1yr)
- Prevent joint damage
- Eliminate tophi
What lifestyle modifications are recommended for people with crystal arthritis? [6]
- Reduce purine intake
- Reduce fructose-containing drinks
- Include skimmed milk, low fat yoghurt, vegetable protein and cherries every day
- Weight loss
- 1 kg/month (avoid crash diets)
- avoid high protein diets
- Moderate exercise
- Reduce alcohol
What drugs are urate lowering therapies used for crystal arthritis? [2]
- Allopurinol
- Start at 100mg increase in 100mg steps every 4 weeks until target or max 900mg daily
- Febuxostat
- 80mg with option to increase to 120mg after 4 weeks if not at target urate
What is reactive arthritis? [2]
- seronegative (for rheumatoid factor) spondyloarthropathies
- develops after an infection occurs elsewhere in the body
What are the risk factors for reactive arthritis? [2]
- Strong association with HLA-B27
- More common in males
List the organisms that cause reactive arthritis under the following headings:
- enteric infections? [5]
- GU infections? [5]
- Enteric Infections:
- Salmonella
- Shigella
- Yersinia
- Campylobacter
- Clostridium
- GU Infections
- Chlamydia
- Trachomatis
- Neisseria Gonorrhoeae
- Mycoplasma Genitalium
- Ureplasma Urealyticum
What is the typical clinical presentation of reactive arthritis? [11]
- Acute onset usually 2-6 weeks post infection
- Warm, swollen, tender joints, usually lower limb.
- Systemically unwell
- elevated inflammatory markers
- malaise
- Triad of Arthritis, Conjunctivitis & Urethritis may occur
What are the typical features of reactive arthritis in joints? [4]
- Lower limb asymmetric oligoarthritis
- Dactylitis (sausage digits)
- Enthesopathy (Achilles tendonitis, plantar fasciitis)
- Inflammatory back pain
What investigations should be done on a patient with suspected reactive arthritis? [6]
- Joint Aspiration to exclude sepsis
- Swabs — urethral/cervical
- Screen for other related infections
- Inflammatory markers ESR & CRP
- Chlamydia serology
- HLA-B27 for prognostic not diagnostic reasons
What are the management options for reactive arthritis?
- mild? [2]
- moderate? [3]
- severe/prolonged? [1]
- Mild
- NSAIDs
- simple analgesia
- Moderate
- NSAIDs
- joint aspiration
- corticosteroid injection
- Severe or Prolonged
- Consider DMARD
