Arthopathies

Questão	Responda
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. Image: Image (binary/octet-stream)
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.

Próximo

Descrição

Resumo de Recurso

Semelhante

	Criado por Jenna Paterson aproximadamente 4 anos atrás