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CNSLF Bone Path 3 - Joint disease/Arthritis (iii) (Infective arthritis…
CNSLF Bone Path 3 - Joint disease/Arthritis (iii)
Seronegative spondyloarthritis
a group of diseases with -ve RF
involvement of sacroiliac joint + spine (sacroilitis + spondylitis)
HLA B27 a/w
ankylosing spondylitis (bamboo spine)
chronic inflamm disorder of lumbar spinal + sacroiliac joints
HLA B27 +ve in 90%
in young males
autoabs directed @ joint elements after infection
peripheral arthritis in 30%
uveitis
aortitis (aortic incompetence)
systemic AA amyloidosis
reactive arthritis (Reiter syndrome)
affects young males
HLA B27 +ve in 80%
AI reaction following chlamydia, salmonella, shigella, yersinia, campylobacter
defined by a triad of...
conjunctivitis
urethritis / cervicitis
arthritis affecting knees, ankles, spine
"can't see can't pee, can't climb a tree"
enteropathic arthritis (a/w IBD esp UC)
psoriatic arthritis
affects 5-10% of patients with psoriasis
arthritis affecting distal interphalangeal joints of hands + toes (sausage finger or toe), ankles, knees, spine
spontaneous remission
Infective arthritis
causes
haematogenous spread most common
spread from adjacent infective foci
direct inoculation: local trauma, insertion of surgical prosthesis
pathogens in suppurative arthritis
S aureus
most common cause in v young + v old
most destructive
Hib: in young children (<2 y/o)
gonococcus: in healthy young sexually active individuals
Strep
E coli
Pseudomonas
salmonella (esp with sickle cell disease)
Clinical features
acutely swollen painful single joint
fever
decreased range of motion
increased WCC
Synovial fluid features
yellow/green
purulent
WCC>50,000, PMNs > 75%
glucose less than in blood
gram stain usually +ve
culture often +ve
TB arthritis
spread from adjacent TB osteomyelitis or haematogenous spread
spine most commonly affected (Pott's), next hip
crosses cart barriers unlike bacterial infections
destructive arthritis - ankylosis (abnormal stiffening + immobility of joint due to fusion of bones) + deformity
typical granulomatous inflamm
Lyme arthritis
transmitted by tick bite
pathogen = borrelia burgdorferi (spirochete)
Hypertropic osteoarthropathy
characterised by new bone formation @ distal end of long bones, in metacarpal + metatarsal bones, + in proximal phalanges
arthritis of adjacent bone
clubbing of digits
patients usually have an underlying disease = most commonly bronchogenic carc
rarely occurs idiopathically - occasionally familial