Sore joints

Question 1

Hx Q to ask with a patient with acute swollen joint

Answer 1

Trauma and weather it is enough for to injury or if not then Hx of bleeding disorders.
Pain and fever - Septic
Diarrhoea/viral/tonsillitis - Reactive/post infective/ Reiter’s
Hx of IBD - mono arthritis
Rash - palpable or on extensors - Vasculitis - Henoch-schonlein purpura
Drug ingestion - serum sickness (rash)
Bone pain/lymphadenopathy/Hepatosplenomegaly - Malignancy - Leukaemia, Neuroblastoma
Chronic - Juvenile chronic arthritis

Question 2

Acute swollen Joint - Trauma

Answer 2

Uncommon in very young child
Caution if acute event was not painful enough to prevent activity immediately
Ix - Xray

Question 3

Acute swollen joint - Acute joint bleed

Answer 3

Especially if young and painful swollen joint from minor trauma
1St presentation for a child wth haemophilia
Ix Coagulation studies

Question 4

Acute swollen joints - Septic arthritis

Answer 4

Pain and fever and swollen
Septic work up - FBC, U and E, BC, urine culture, CXR, LP?
ABx - Flucloxacillin.
Organism - staph, strept pneumonia or GAS.

Question 5

Acute swollen joint - Reactive/post infective

Answer 5

Hx of resent diarrhoea (salmonella,shigella, Campylobacter)
Viral illness (Parvovirus, Rubella, EBV, Mumps)
Tonsillitis
Mono arthritis lg joints (if poly think ARF)
Fever
Ix - FBC, ESR, Serum Albumin, stool microscopy

Question 6

Management of acute swollen joint

Answer 6

Ix - FBC, ESR/ CRP
Refer
- trauma orthopaedics
- Joint bleeds to orthopaedic or haematology
- Septic - orthropaedics
- Malignancy to haematology oncology

Question 7

Acute swollen joint IBD

Answer 7

Large joint mono arthritis migratory

Tx analgesia, sulfasalazine

Question 8

Acute swollen joint - Vasculitis

Answer 8

Rash - palpable, Pulsitile
Henoch - Schonlein Purpura
Ix - ESR/ FBC Urinalysis, U and E
Tx - Rest, admit, analgesia, steroid to help abdo pain.