Swollen Joint Flashcards
What are the typical investigations done for a swollen joint?
FBC
CRP
U+Es
Serum Urate
X-ray
Joint aspiration
What are the management steps if a patient has red flag sepsis secondary to septic arthritis?
Blood cultures
Lactate
Urine output
02
IV fluids
IV abx
What is the typical causative organism of septic arthritis?
Staphylococcus aureus
How does staphylococcus aureus appear on gram staining?
Gram +
Cocci
Clusters
What are some causative organisms of septic arthritis?
Staphylococcus aureus
Streptococcus pneumoniae
Neisseria Gonorrhoea
Why does you sometimes aspirate joints if they are swollen in ED and other times in theatre?
Aspirate in theatre if patient has Intra articular metal work.
What are some causes of knee infections?
Osteomyelitis
Bursitis
Cellulitis
Joint space
Myositis
How are infected bursitis different to bursitis?
With bursitis patients aren’t typically systemically unwell and bursa isn’t very red or hot
What investigations do you do on a joint aspirate?
WCC
Crystal analysis
Cultures
Gram staining
What are the methods of spread to causes septic arthritis?
Haematogenous spread
Spread from adjacent infection
Direct innoculation
How does a patient with septic arthritis of the knee typically present?
Antalgic gait
Painful joint
Red swollen joint
Reduced ROM
Pyrexia
Rigours
How is septic arthritis managed?
Sepsis 6
Joint aspirate
Joint wash out (remove any infected metal work/joint prosthesis)
What are some complications of septic arthritis?
Sepsis
Osteomyelitis
Death
Osteoarthritis
What are some differentials of a painful swollen joint?
Septic arthritis
Gout
Pseudogout
Bursitis
Rheumatoid arthritis
Psoriatic arthritis
Fracture
What are the risk factors of gout?
Diet
Alcohol
Obesity
Family history
CKD
Men
What is the drug used to manage chronic gout?
Allopurinol
(Reduces bodies uric acid levels)
What are the 2 medications that can be given for acute gout?
Naproxen (NSAID)
Colchicine (when NSAID contraindicated)
What are the contraindications to NSAIDs?
Peptic ulcers
GI bleeds
Renal impairment
Severe heart failure
Hepatic impariment
Pregnancy (early closing of ductus Arteriosus)
What is visible on examination when a patient has gout?
Gouty typhi (yellowing)
Erythemmma
Swelling
What type of crystals are gout crystals?
Negatively birefringent needle shaped crystals
What type of crystals are Pseudogout crystals?
Postitively birefrigent rhomboid shaped crystals
P for positive and Pseudogout
What joint does gout typically affect?
1st metatarsalphalangeal joint
What joint does psuedogout typically affect?
Knee joint
What investigations are done for gout/psuedogout?
Serum Urate
Joint aspirate if uncertain (potential septic arthritis)
What is the pathophysiology of pseudogout?
Calcium pyrorphosphate deposits on JOINT CARTILAGE (CHONDROCALCINOSIS)
