Rheumatological emergencies

Posted by e-Medical PPT
Septic Arthritis
Arthritis due to seeding of a joint by a bacteria, mycobacterium or fungus.
Usually by hematogenous spread
Classified as gonococcal or non-gonococcal
Non-gonococcal arthritis is the more potentially destructive form

Young, healthy adults
Migratory polyarthralgias/arthritis
Tenosynovitis common
Rare positive Bcx
Positive joint cultures >25%

Young children, elderly, Immunocompromised
Tenosynovitis rare
Positive Bcx 40-50%
Positive joint cultures >95%

Giant Cell Arteritis
Vasculitis of medium and large vessels arising from aortic arch
Patients generally over the age of 50; average age is 70
Multinucleated giant cells infiltrate vessels leading to patchy involvement  
Presents with polymyalgia rheumatica in 40% of cases
PMR= symmetrical pain/stiffness in shoulder and pelvic girdle muscles for more than 1 month in a patient age >50 with elevated ESR with rapid response to steroids

Diagnosis of GCA
Diagnose with 3/5 of the following:
Age > 50 years
New headache
Temporal artery abnormality
ESR > 50mm/hr
Abnormal artery biopsy with mononuclear cell infiltrate, granulomatous inflammation,usually with multinucleated giant cells

Heterogeneous group of disorders with thickened skin as a hallmark
Endothelial disruption and fibroblast proliferation with unknown etiology
Categorized into localized and systemic

Localized Scleroderma
Affecting cutaneous and subcutaneous tissues only
a. Morphea-localized and generalized; patches of sclerotic skin on trunk and limbs
b. Linear- most common in childhood; abnormalities skin and subcutaneous tissues which often follow dermatomal distribution and are found predominantly on one side of the body

Systemic Scleroderma
Skin and internal organ involvement
Skin involvement limited to hands, face/neck
pulmonary HTN, GI involvement
Anti-centromere antibody

Extends proximal to MCPs, involves trunk
ILD, CV disease, renal disease, joint deformities, myopathy

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