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35 Cards in this Set

  • Front
  • Back
Approach to monoarthritis
Inflammatory vs non-inflammatory:
Non-inflammatory = osteoarthritis
Inflammatory = Infection, crystals, blood, other
Infection = Staph, Gonococcal, Fungal, other
Crystal = gout, pseudogout
Blood = trauma, coagulopathy
Septic Arthritis: Causes
Hematogenous spread of:
Gram-positive cocci (75-80%)
Gram-negative bacilli (15-20%)
S. aureus is most common
Septic Arthritis: Risk Factors
Recent infection
Portal of entry
Prosthetic joint
Diseased/deformed joint
*Sexual activity (gonococcal)
Septic Arthritis: Presentation
Acute pain and swelling
Knee and HIp
Septic Arthritis: forms of gonococcal infection
1. Typical septic arthritis
2. Disseminated gonoccocal infection (DGI)
Signs of DGI
Migratory arthritis + skin lesions + tenosynovitis
Positive cultures at sites other than blood and synovial fluid
Septic Arthritis: Synovial fluid characteristics
Low viscosity
WBC > 2000 with high percentage of pmn cells
Septic Arthritis: Blood work findings
Elevated WBC
Elevated ESR
Septic Arthritis: Xray findings
Synovial effusion and soft tissue swelling
No us except as baseline image
Septic Arthritis: Management
Synovial fluid cultures for GS and culture
If turbid and purulent then empiric antibiotics
Refine antibiotic choice based on culture results
Daily needle drainage
Early physio
Septic Arthritis: Antibiotic choices
Gram +ve cocci: vancomycin
Gram -ve bacilli: 3rd generation cephalosporin
Gonococcal: ceftriaxone
* IV 1-2wks then oral 2-4wks
Septic Arthritis: Prognostic factors
Old age
Preexisting joint disease
Presence of prosthetic joint
Crystal induced arthritis: types of crystals
monosodium urate: gout
calcium pyrophosphat (CPPD): pseudogout
Calcium hydroxyapatite
3 C's of synovial fluid analysis post arthrocentesis
Cell Count
Crystal induced arthritis: pathogenesis
Crystals deposit in synovial tissue, cartilage and periarticular structures
Crystals promote acute inflammatory attacks
Destructive changes if becomes chronic
Gout: epidemiology
Men >40, Women post-menopausal
Joints: 1st MTP, ankle, foot
Gout: Uric acid regulation
Dietary intake: red meat, fish, beer will increase production
Synthesis: critical illnesses, ethanol, etc. will increase production
Excretion: renal failure, metabolic syndrome, diuretics will decrease excretion
Tophaceous deposits
Deposits of urate crystals seen in chronic untreated gout
Crystal induced arthritis: diagnosis
1. Presence of acutely inflammed joint
2. Presence of crystals in synovial fluid
Crystal induced arthritis: Role of Xrays
Indicate chronic gout disease
Cannot see acute gout
Pseudogout (calcium pyrophosphate dihydrate deposition disease): pathogenesis
Release of crystals from cartilage into joint leads to inflammation and pain
Pseudogout (calcium pyrophosphate dihydrate deposition disease): epidemiology
Joints: wrist and knee
Pseudogout (calcium pyrophosphate dihydrate deposition disease): role of xrays
May indicate CPPD
Crystal induced arthritis: hydroxyapatite epidemiology
Joints: shoulder, hip, 1st toe
Crystal induced arthritis: Management of acute attacks
Rest, ice analgesia
corticosteroid injection
NSAIDS: mechanisms of action
NSAIDS: adverse effects
Renal dysfunction
Salt and water retention (hypertension, heart failure)
Dyspepsia/GI ulceration
Inhibition of uterine motility
Allergic reactions
NSAIDS: prevention of grastropathy
Try acetominophen first
Switch to Cox-2 specific
Prostaglandin E1 analogue
Colchicine: mechanism of action
disrupts chemotaxis and phagocytosis of urate crystals to reduce inflammation
Colchicine: side effects
Early: diarrhea and abdo pain
Severe: bone marrow suppression, multi-organ failure
Crystal induced arthritis: Prevention
Dietary modification
Avoid drugs that increase uric acid (diuretics, ASA, cyclosporine, ethanol)
Urate lowering therapy (Urocosurics, allopurinol)
Urate lowering therapy
Uricosurics: increase excretion of uric acid
Xanthine oxidase inhibitors (allopurinol): decrease production of uric acid
Allopurinol indications
Recurrent gouty attacks
Tophaceous gout
Allopurinal side effects
Initiation of gout attack (start with colchicine)
Interstitial nephritis
Hypersensitivity rxn
Management of pseudogout and acute hydroxyapatite arthritis
Same as gout but no preventative therapy available