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Flashcards in An acute hot swollen joint Deck (12):
1

Differential

Septic arthritis
Crystal synovitis->gout or pseudogout
Inflammatory arthritis->RA and seronegative arthropathies
Transient synovitis
Haemarthrosis

2

History

Pain->septic and gout tend to have ++pain

Age and sex->all can present in adult, septic/reactive/inflammatory in child. Gout +in men. RA + in women.

Which joint:
-Gout-> first MTP
-Pseudogout->knee and wrist
-Multiples->inflammatory

Is the patient ill

Previous history->90% gout will have recurrent

Associated-> systemic features. Eye in reiters (conjunctivtis), RA (keratoconjunctivitis), JIA (uveitis)

History of STDs/Diarrhea
Recent viral infection

PMHx:
- malignancy, chemotherapy
-IVDU
-Bleeding disorder

Drug history:
- Diuretics + low dose aspirin + gout
-steroids = +risk of infection

Social:
- Alcohol->gout

3

Examination

General:
-Fever, systemically unwell
-Rash, gouty tophi, eye signs
-Evidence of inflammatory disease

Joint:
-Complete joint examination
-Examination of others to exclude monoarthritis

4

Investigations

FBC->leukocytosis in infection, and inflammation
ESR/CRP can be elevated in all
Calcium->may be elevated in pseudogout
Serum urate
Clotting screen if suspect haemarthrosis

XR->may be normal, show chondrocalcinosis of pseudogout, bony arosions with gout or inflammatory arthitis

Joint aspirate->send for MCS

USS->useful to detect effusion

5

Most commonly affected joints with infection

Knee
Hip
Shoulder

6

Causes of chronic monoarticular/involvement of 2-3

Mycobacterium
Fungi

7

When does bacterial infection of joint most commonly occur and why

RA
Chronic inflammation + steroids predisposes to S aureus.

8

Most likely infection of joints in IVDU

Strep
Staph
Gram negative
Pseudomonas

9

Specific diagnostic criteria for RA

Morning stiffness
>3 joints
Hand joints
Symmetric
Rheumatoid nodules
+RF
Radiographic changes

First four +ve for 6 weeks, and any four to diagnose

10

Common blood results for RA

RF +ve, elevated erythrocyte sedimentation rate, an elevated C-reactive, protein, anemia, thrombocytosis, and low albumin

11

What is the target uric acid level for gout

12

Most common causes of red hot joint

Infection
Crystals
Trauma