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

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


Non-gonococcal
Young children, elderly, Immunocompromised
Monoarthritis
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

Scleroderma
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
Limited/CREST
Skin involvement limited to hands, face/neck
pulmonary HTN, GI involvement
Anti-centromere antibody

Diffuse
Extends proximal to MCPs, involves trunk
ILD, CV disease, renal disease, joint deformities, myopathy
Anti-Scl-70


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