Difference between revisions of "Monoarticular arthritis"

(Created page with "==Septic Arthritis== === === ===Gonococcal Arthritis=== Healthy, young sexually active adults Women > men Suppurative monoarthritis (may be preceded by polyarthralgias...")
 
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==Septic Arthritis==
 
==Septic Arthritis==
 
 
=== ===
 
 
  
 
===Gonococcal Arthritis===
 
===Gonococcal Arthritis===
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-Asymmtric polyarthralgia of extremity joints
 
-Asymmtric polyarthralgia of extremity joints
  
DiagnosisCx everything - jt, mucosal surfaces, lesions
+
DiagnosisCx everything - jt, mucosal surfaces, lesions
  
TreatmentCTX 1gIV qd OR
+
TreatmentCTX 1gIV qd OR
  
 
Cefotax 1g q8
 
Cefotax 1g q8
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-Postop
 
-Postop
  
CausesBacterial
+
CausesBacterial
  
 
Mycobacterial
 
Mycobacterial
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Postinfectious
 
Postinfectious
  
DiagnosisSynovial fluid aspiration
+
DiagnosisSynovial fluid aspiration
  
 
Cx - if only one test, use BCx bottles (may enhance yield)
 
Cx - if only one test, use BCx bottles (may enhance yield)
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Cell count with dif - >50,000-150,000; PMN > 90%
 
Cell count with dif - >50,000-150,000; PMN > 90%
  
TreatmentPCN-ase resistant synthetic PCN:
+
TreatmentPCN-ase resistant synthetic PCN:
  
 
Nafcillin 1-2g
 
Nafcillin 1-2g
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== ==
 
 
  
 
==Crystal-Induced Monoarthritis==
 
==Crystal-Induced Monoarthritis==
  
 
=== ===
 
  
  
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Precipitants: purine-rich food, EtOH, trauma, chemo, diueretic use, RI
 
Precipitants: purine-rich food, EtOH, trauma, chemo, diueretic use, RI
  
DiagnosisSynovial fluid aspiration (above)
+
DiagnosisSynovial fluid aspiration (above)
  
 
Note: serum uric acid levels unhelpful; ESR/CRP may be elevated
 
Note: serum uric acid levels unhelpful; ESR/CRP may be elevated
  
TreatmentNSAIDS eg Naproxen 500mg po bid x 3d and taper over 4-7d
+
TreatmentNSAIDS eg Naproxen 500mg po bid x 3d and taper over 4-7d
  
 
Colchicine 0.6mg po qh x 3 or 1mg PO f/b 0.5mg q1h until relif, GI upset, or 8mg max
 
Colchicine 0.6mg po qh x 3 or 1mg PO f/b 0.5mg q1h until relif, GI upset, or 8mg max

Revision as of 01:01, 2 March 2011

Septic Arthritis

Gonococcal Arthritis

Healthy, young sexually active adults

Women > men


Suppurative monoarthritis (may be preceded by polyarthralgias)

Knee, wrist, ankle


Arthritis-Dermatitis Syndrome

-Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes)

-Skin lesions: scattered small painless erythematous macules or petechiae-->pustular -->necrotic lesions

-Transient painful extensor tenosynovitis (writs, hands, ankles)

-Asymmtric polyarthralgia of extremity joints

DiagnosisCx everything - jt, mucosal surfaces, lesions

TreatmentCTX 1gIV qd OR

Cefotax 1g q8

Empirically treat Chlamydia


Nongonococcal Arthritis

Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly

-Hematogenous

-Contiguous

-Direct traumatic implantation

-Postop

CausesBacterial

Mycobacterial

Spirochete (lyme, syphilis)

Fungal

VIral (HIV, Hep B, Rubella, etc)

Postinfectious

DiagnosisSynovial fluid aspiration

Cx - if only one test, use BCx bottles (may enhance yield)

Grm stain - 80% positive in gram-positive infxn; less sens in gram-negative

Cell count with dif - >50,000-150,000; PMN > 90%

TreatmentPCN-ase resistant synthetic PCN:

Nafcillin 1-2g

Cefazolin 1-2g

AND

3rd gen ceph

OR

Vanc*

  • new evidence suggests significantly increased rate of MRSA septic arthritis
    • cell counts are as low as 20,000 in MRSA Cx + synovial fluid


Crystal-Induced Monoarthritis

Gout

Monosodium urate crystals - needle shaped negative birefringence

Swelling, redness, warmth evolving rapidly over hours todays

First MTP (podagra) 60% > ankle > midfoot > knee

May have constitutional complaints

Precipitants: purine-rich food, EtOH, trauma, chemo, diueretic use, RI

DiagnosisSynovial fluid aspiration (above)

Note: serum uric acid levels unhelpful; ESR/CRP may be elevated

TreatmentNSAIDS eg Naproxen 500mg po bid x 3d and taper over 4-7d

Colchicine 0.6mg po qh x 3 or 1mg PO f/b 0.5mg q1h until relif, GI upset, or 8mg max

Can give 1-2mg IV over 30mins

  • No further doses after initial load
    • avoid NSAIDS, Colchicine in RF

Steroids

-Prednisone 40-60mg po qd x 3d f/b 7d taper


Pseudogout

Calcium pyrophosphate dihydrate (CPPD) - rhomboid shaped positive birefringence

chondrocalcinosis

acute attacks of mono or oligoarticular inlammatory arthritis

progressive joint deenerative changes similar to OA

Evolves over days

Age > 50

Knee, wrists, ankles, elbows

Systemic illness, surgery, trauma triggers

Assoc with hyperparathyroidism and hemochromatosis


Traumatic

Fracture

ligamentous

Overuse


Ischemic

Avascular necrosis

Decompression illness

Spontaneous osteonecrosis

pain in abscence of trauma

femoral head, medial conyle of knee


Hemorrhagic

Posttraumatic

-Joint aspiration if tense

-RICE

Hemophilia

Systemic anticoagulation


Neoplastic

Mets

Osteochondroma

Osteoid osteoma

Pigmented villonodular synovitis


Systemic Disease

Remote infxn, infectious endocarditis

Rheumatic fever

Seronegative (no RF) spondyloarthropathies (AS, IBS, psoriatic, reactive or Reiter's)

Rheumatoid arthritis, SLE

Sarcoidosis, amyloidosis


Periarticular

these conditions mimic joint involvement...

Cellulitis

Tendonitis

Bursitis


Peds

don't forget about...

Acute Transient Synovitis

-Children 3-10yo

-1-3 wks after viral illness

Self-limited

SCFE (portly pubescent)

Leff-Calve-Perthes (young school-age children)


Source

H-N