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Flashcards in 27. Acute Joint Pain Deck (29)
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1

What diagnosis must you exclude in a patient with acute joint pain?

Septic arthritis

2

What are 4 articular causes of single acutely painful joints in adults?

Trauma
Gout
Pseudogout
Septic arthritis

3

What are 5 peri-articular causes of single acutely painful joints in adults?

Ligament injury
Tendinitis
Bursitis
Fascitis
Epicondylitis

4

What are 2 non-articular causes of single acutely painful joints in adults?

Nerve entrapment
Radiculopathy

5

Pain that is worse on movement and improves with rest is likely to be...

Non inflammatory

6

Acute joint pain- list 4 causes with rapid onset

Septic arthritis
Gout
Pseudogout
Trauma

7

Joint pain- list 2 causes with insidious onset

Bursitis
Tendonitis

8

What are 6 common risk factors for gout?

Thiazide diuretics
Recent heavy alcohol intake
Chronic renal failure
Chemotherapy
Hx renal stones
Hx gout

9

What are 2 common risk factors for septic arthritis?

Immunosuppression (diabetes, HIV, steroids)
Prosthetic joints

10

What are 3 risk factors for haemarthrosis?

Coagulopathies (haemophilia)
Anticoagulant use (warfarin)
Trauma

11

Acute joint pain- what do you need to ask about in PMHx?

Recent GI or urethral infection: take a sexual hx as gonoccal infection can be asymptomatic + lead to septic arthritis
Previous episodes? (recurrent conditions- crystal arthropathies + overuse)
Rheumatological conditions?

12

Why is the pattern of joint involvement important in acute joint pain?

Involvement of joints sequentially= gonococcus + rheumatic fever
Several joints simultaneously= chronic polyarthritis

13

What should you do on joint examination?

Look, feel, move
Look: erythema, scars, swelling, muscle wasting, bony deformities, asymmetry
Feel: effusions, tenderness on bones, ligaments, tendons along joint line, temperature + neurovascular status
Move: test full range of passive + active movement

14

What are articular conditions more likely to present with?

Diffusely inflamed joint (red, hot, painful)
Pain on passive + active motion

15

What are peri-articular conditions more likely to present with?

Focal point of tenderness on palpation
Pain worse on active instead of passive movement

16

What should be examined beyond joints?

Skin: Tophi, Rheumatoid nodules + Rashes
Nail: pitting, subungual hyperkeratosis, onycholysis (signs of psoriasis)
Uveitis: inflammation of middle layer of eye
Mouth ulcers: possible crohn's
Lung fibrosis (associated with inflammatory arthropathies e.g. RA)

17

Describe the possible results of arthrocentesis

Crystals may be present in gout
Infection: cloudy aspirate
Blood: haemarthrosis seen in trauma
Fat globules: fracture
White cells: inflammation

18

What are second line investigtions after arthrocentesis for acute joint pain?

Cultures
FBC
CRP
ESR
PT for coagulopathy in haemarthrosis
RA?: Rheumatoid factor, anti-CCP + ANA
Serum urate (though often L/N in acute gout)
Plain radiographs
MRI: soft tissue injury

19

What is acute management of gout?

Colchinine (contra indicated in patients with renal or hepatic impairment)
NSAIDs
Corticosteroid injections

20

What is the chronic management of gout?

Decrease urate production: allopurinol + febuxostat
Increase urate excretion: sulfinpyrazone + probenecid
Increase degradation of urate: rasburicase

21

Joint pain- what may present with chronic onset?

Osteoarthritis

22

Give 3 drugs that can predispose to gout?

Thiazides
Low-dose aspirin
Ciclosporin

23

What class of drugs can predispose to osteoporosis?

Steroids

24

How do the crystals differ in gout and pseudogout?

G: Urate: Negatively bi-refringent + needle shaped
P: Calcium pyrophosphate: Positively bi-refringent + rhomboid

25

Why must colchicine always be prescribed with allopurinol in the first 6 weeks?

Initial doses of allopurinol can paradoxically result in acute gout

26

Describe the management of septic arthritis

Analgesia
Take blood cultures
Give broad spectrum Abx
Joint aspiration + lavage

27

What is the most likely infective organism in a native joint?

Staphylococcus aureus

28

What is the most likely infective organism in a prosthetic joint?

Staphylococcus epidermis

29

Give 4 features of osteoarthritis on a plain radiograph

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts