26337520
Descripción
Fichas por Jenna Paterson, actualizado hace más de 1 año
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Creado por Jenna Paterson
hace casi 4 años
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| Pregunta | Respuesta |
| What is reactive arthritis? | A seronegative arthropathy. Member of the spondyloarthitides, which are disorders linked by similar symptoms and HLA B27. |
| What are spondyloarthritides? | Spondyloarthritis is an umbrella term for different types of inflammatory arthritis. These include reactive, psoriatic, ankylosing spondylitis, enteropathic arthritis and undifferentiated spondyloarthritis. |
| What are seronegative features? | Pain and inflammation in joints (worse in the morning and after periods of inactivity) Uveitis/iritis Dactylitis, enthesitis Psoriasis IBD Inflammatory back pain |
| What are the 2 main types of spondyloarthritis? | Axial - involving SIJs/spine/costovertebral region Peripheral - involving dactylics, enthesitis, joint inflammation and tendonitis |
| What is dactylitis, enthesitis, and what are they a feature of? | Dactylitis = inflammation of a digit --> 'sausage' finger or toe. Not a feature of RA or OA but found in spondyloarthritis, congenital syphilis and rarely as extra-pulmonary TB. Enthesitis = inflammation of the enthesis - where tendons and ligaments attach to bone. Commonly seen at Achilles' tendon and caused by SpAs. Not a feature of RA/OA. |
| What are the clinical features of reactive arthritis? | - Usually presentation of an acute monoarthritis (often knee, and other joints of lower limb) following an infection (often GI/GU (i.e. STI). The infection can have occurred 2-6 weeks before. - Extra-articular inflammation - dactylitis, tenosynovitis, enthesitis, uveitis, urethritis |
| When found in combination with oligoarthritis, what is a diagnostic clinical finding for reactive arthritis? |
Keratoderma Blennorrhagicum on palms or soles.
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| What are some common causative organisms of reactive arthritis? | Y. Salmonella (GI) Shigella (GI) Camplyobacter (GI) C. pneumoniae (Resp) C. Trachomatis (STI) |
| What would be the features of a joint aspirate of inflammatory fluid, with regards to colour, clarity, viscosity, WBC and % PMN? Give some examples of the cause. | Colour - pale yellow (normal) Clarity - opaque (should be clear) Viscosity - low (should be high) WBC >=2000 (should be <200) %PMN >=25% (should be <25%) Examples = seropositive, seronegative and crystal arthropathies |
| How is reactive arthritis treated? | Treat underlying infection with Abx NSAIDs for pain Steroids if fails to settle |
| What is the most commonly affected joint in septic arthritis? | Knee, followed by ankle then shoulder. (except in children = hip) |
| What can cause septic arthritis? | Usually haematological spread of infection OR Recent penetrating injury |
| What are the causative organisms of septic arthritis? | Almost always bacteria. Most common = staphylococcus aureus (gram +ve cocci) Also; staphylococcus epidermidis in prosthetic joints, Neisseria gonorrhoeae (gram -ve cocci) in sexually active and gram -ve bacilli in diabetics, elderly and IV drug users. |
| What are risk factors for septic arthritis? | - Older people - IVDU - Recent sepsis - Diabetes - Immunocompromised - Haemoglobinopathies - Underlying joint disease - OA, RA Prosthetic joint |
| Key clinical features of septic arthritis? | - Typically an acute, hot, swollen and tender joint - Loss of function - Fever Raised WCC/CRP |
| What would be the features of a joint aspirate indicative of septic arthritis, with regards to colour, clarity, viscosity, WBC count, culture/gram stain and % PMN? | Colour - yellow to white Clarity - opaque (should be clear) Viscosity - low or paradoxically high if purulent (should be high) WBC >50,000 (should be <200) %PMN >75% (should be <25%) |
| How is septic arthritis managed in native and prosthetic joints? | IV flucloxacillin is first line Native joints will need daily aspiration of infection Prosthetic joints are an ortho problem and require prolonged antibiotics/surgical joint wash outs. |
| What is Reiter's syndrome? | Term not used anymore but synonymous with reactive arthritis and consists of a triad of uveitis, urethritis and joint inflammation. 'Can't see, can't pee, can't climb a tree' |
| What is gout? | Monosodium urate crystal deposition in synovial fluids and soft tissues |
| What are the risk factors for gout? | - High uric acid levels - M:F ratio 4:1 - Red meat, shellfish, alcohol - Diuretics (particularly thiazide) - Obesity, HTN, CHD, T2DM |
| How does acute and gout present? | - Usually monoarticular (80%) - Typically involves 1st MTP, then other lower limb joints - Asymmetrical polyarthropathy in 10% (>5 joints) Chronic gout: - Linked to tophi (deposits of uric acid crystals) - Seen on hands, feet, ears - Linked to uric acid kidney stones |
| How is gout diagnosed? | Joint aspirate which shows negatively bifringent needle shaped crystals. Also bloods often show raised WCC, CRP. Urate can be normal or low. |
| What X-Ray changes may be seen in gout? | Acute - soft tissue swelling Chronic - punched out erosions Or may be normal |
| How is gout treated? | Acutely: one of NSAIDs, colchicine, steroids plus rest/icepacks Chronic: allopurinol plus NSAID/colchicine. Lifestyle - drink less, eat better, lose weight, change diuretic |
| What is pseudogout? | Deposition of calcium pyrophosphate dihydrate crystals in cartilage, which damage the cartilage and cause inflammation and pain. |
| What are the risk factors for pseudogout? | M:F ratio 1:1 Age >60 (crystals can build up with age) |
| How does pseudogout present and what joints does it commonly affect? | Can present with an acute monoarthropathy or sub acute asymmetrical oligoarthritis The knee is affected in 50% of cases Can also affect wrists, MCPs, elbows and shoulders |
| What other conditions is pseudogout often associated with? | Haemochromatosis Hypomagnesaemia Hyperparathyroidism Hypothyroidism OA (gout increases risk of OA) Wilsons disease |
| How is pseudogout diagnosed? | Joint aspirate (synovial fluid microscopy) shows presence of positively bifringent, rhomboid-shaped crystals. |
| What X-Ray changes can be seen in pseudogout? | Chondrocalcinosis (as a result of crystals within joint line) |
| How is pseudogout managed? | Acute: one of NSAIDs, colchicine or steroids. Allopurinol is NOT effective in pseudogout prevention. For severe attacks/chronic inflammation, MTX or IL beta-1 antagonist can be used. |
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