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w138 gout > Monoarthritis. > Flashcards

Monoarthritis. Flashcards

1
Q

What are the 4 Main types of monoarthritis? +3 differentials.

A

Septic arthritis, Crystal arthritis, osteoarthritis, Haemarthritis (trauma). + Sero-negative arthritis, reactive arthritis, sarcoid.

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2
Q

What is septic arthritis?

A

Septic arthritis is Acute inflammation of joint caused by direct infection. It can destroy a joint in less than 24hrs.

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3
Q

What are the main causes of Septic arthritis?

A 
Infection can go unnoticed or be weeks previous.
–Bacterial
•Stap aureus - majority
•Nisseria Gonococcus – younger adults
•Streptococcus
•E.coli / others (salmonella, proteus)
–Mycobacterial
–Rarely fungal / viral
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4
Q

What are the risk factors for Septic arthritis?

A

pre-existing joint disease 9esp rheumatoid arthritis), Diabetes mellitus, immunosuppression, chronic renal failure, recent joint surgery, IVDU, HIV.

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5
Q

What is the treatment for septic arthritis?

A

If in doubt start IV antibiotics.

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6
Q

What is gout?

A
  • It is an acute monoarthropathy with sever joint inflammation.
  • > 50% occur at the metatarsalphalangeal joint of the big toe.
  • It is caused by deposition of monosodium urate crystals.
  • in chronic longterm cases there are deposits of trophi.
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7
Q

What is and what causes gout? what is gout a marker for?

A
  • Gout is a clinical syndrome caused by an inflammatory response to monosodium urate monohydrate crystals which may form in people with hyperuricaemia
  • It is caused by Rich fatty foods and alcohol ↑ dietry purines. Family Hx.
  • Gout can be a marker for:
  • Cardiovascular disease
  • Hypertension
  • Diabetes
  • chronic renal failure
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8
Q

Patient presents with a sudden / subacute onset of pain in the knee (one limb). They have difficulty weight-bearing / moving. They have swelling and erythema. What could the diagnosis be?

A

Septic arthritis.

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9
Q

What is the first thing you treat in septic arthritis?

A

Sepsis!!! Always suspect and hit them with a systemic antibiotic.

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10
Q

What is the main cause of gout?

A

overproduction of urate crystals.

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11
Q

What are the risk factors in gout?

A

Non-modifiable are: Age, male gender, Genetic factors, Impaired renal function.

Modifiable: Hyperuricaemia, High-purine diet, Alcohol consumption, Obesity, Certain medications–diuretics

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12
Q

What are the clinical features of gout?

A
  • Most commonly affects middle aged males
  • Acute, relapsing self-limiting severe inflammatory arthritis
  • Chronic form associated with tophus formation and bone and joint destruction
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13
Q

What are tophi?

A
  • A tophus is a deposit of uric acid crystals, in the form of monosodium urate crystals.
  • They are linked to chronic gout.
  • Chronic tophaceous gout is known as Harrison Syndrome.
  • Tophi form in the joints, cartilage, bones, and other places throughout the body. Sometimes, tophi break through the skin and appear as white or yellowish-white, chalky nodules.
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14
Q

What are the investigations for gout?

A

Synovial joint fluid aspiration. Rule out septic arthritis and look for conformation of diagnosis via polarized light microscopy.

In bloods:
–Urate, Urea and creatinine, Blood sugar, Fasting lipids
–LFT
•Urinalysis for blood and protein
•Acute attack
–CRP
–NB URATE MAY BE NORMAL DURING ACUTE FLARE

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15
Q

What is the treatment for gout?

A

NSAID or COXIB. steroids in renal impairment.

•Prevention and treatment of hyperuricaemia
–Seek and correct factors contributing to hyperuricaemia e.g regular alcohol, high purine intake, obesity, diuretic therapy, hypertension
–Use a urate lowering drug regularly and permanently

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16
Q

Name 2 urate lowering drugs?

A

Allopurinol and febuxostat.

17
Q

What is pseudogout?

A

Like gout but not. Calcium crystals instead of urate crystals.

•Demographic different
–Elderly (women)
•Knee / wrists most commonly involved
•Attacks can last much longer
•There is no specific treatment
18
Q

What is the treatment for pseudogout?

A

–Analgesia
–Steroid injection
–Joint replacement

19
Q

What is reactive arthritis?

A 
It is a spondylo-arthritis linked to proceeding infection that is not post viral. Common triggering infections are: •Salmonella
•Campylobacter
•Chlamydia
•Yersinia
•Shigella
20
Q

What is reiters triad?

A

Urethritis, arthritis and conjunctivitis all linked to reactive arthritis.

21
Q

What are the clinical features of reactive arthritis?

A

Preceeding infection - typically urethritis or diarrhoea.

An asymmetrical mono / oligoarthritis (

22
Q

What clinical features could you find in reactive arthritis?

A

–Conjunctivitis → often painless
–Balanitis
–Keratoderma Blennorhagica → crusty feet
– Reiters triad

23
Q

What is the treatment for reactive arthritis?

A 
•Physiotherapy
•Pharmacological:
- NSAIDs
- Steroids – oral / intra-articular / IM
- DMARDs:
Methotrexate
Sulphasalazine
Leflunomide
- Biologics: anti-TNFalpha

w138 gout (1 decks)

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