tuberculous arthritis

Unlike tuberculous osteomyelitis, which typically involved the thoracic and lumbar spine (50 percent of cases), tuberculous arthritis primarily involves the large weight-bearing joints, in particular the hips, knees, and ankles, and only occasionally involves smaller non weight bearing joints.

Progressive monarticular swelling and pain and develop over months to years, and systemic symptoms are seen in only half of all cases. Coexistent active pulmonary tuberculosis is unusual.

Aspiration of involved joint yields fluid with an average cell count of 20,000/µL, with approximately 50 percent neutrophils. Acid fast staining of the fluid yields positive results in fewer than one-third of cases, and cultures are positive in 80 percent.

Mercedes Benz scar

Mercedes Benz scar

This is the coolest thing I learned about today. The Mercedes Benz scar indicates previous liver transplant. In the patient we saw the lower parts of the sacar did not have an angle so it looked more like two scars, a transverse with a midline ie: like the mathematical sign for parallel. I get excited by scars I don't know about as you might have already realised :)) I think it is because I like patterns... and also this one is particularly exciting because of the name- it hasn't been long since I used to read the car brand as the French for Wednesday (Mecredi), so the mention of Mercedes makes me laugh at my dyslexic tendencies :)

Pauciarticular JRA

Definition: Pauciarticular JRA refers to a form of juvenile rheumatoid arthritis which affects four or fewer joints. Pauciarticular is the most common form of JRA; about half of all children with JRA have this type. This type of JRA affects mostly girls. Girls under age 8 are most likely to develop this type of JRA. Pauciarticular disease is a disease of few joints. It most commonly affects the knees, elbows, wrists, and ankles. The joints are usually affected asymmetrically (one joint on one side). Children affected by pauciarticular disease usually have a positive antinuclear antibody (ANA) test and are prone to an inflammatory eye condition, iridocyclitis. Children with pauciarticular JRA generally do well.

arthritis

Oligoarthritis is a type of arthritis defined by inflammation of two to four joints. It is also a name for a common form of juvenile idiopathic arthritis called pauciarticular juvenile rheumatoid arthritis. Olig is Latin for "few," differentiating it from polyarthritis, which affects five or more joints, and monoarthritis, which typically only affects one.

Septic arthritis

Septic arthritis should be suspected when one joint (monoarthritis) is affected and the patient is febrile. In seeding arthritis, several joints can be affected simultaneously; this is especially the case when the infection is caused by staphylococcus or gonococcus bacteria.

Diagnosis is by aspiration (giving a turbid, non-viscous fluid), Gram stain and culture of fluid from the joint, as well as tell-tale signs in laboratory testing (such as a highly elevated neutrophils (approx. 90%), ESR or CRP).

Keratoderma blenorrhagica

Other features of this syndrome include Keratoderma blenorrhagica

reactive arthritis

Bacteria associated with reactive arthritis are generally enteric or venereal and include the following:, Salmonella typhimurium, Salmonella enteritidis, Streptococcus viridans, Mycoplasma pneumonia, Cyclospora, Chlamydia trachomatis, Yersinia enterocolitica, and Yersinia pseudotuberculosis.

Remember that always suspect this in young patients who come in with large mono- or oligoarthritis especially knee pain

Reactive arthritis

been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. A useful mnemonic is "the patient can't see, can't pee and can't bend the knee".t most commonly strikes individuals aged 20-40, is more common in men than in women, and is more common in white men than in black men. most common of which would be a genital infection with Chlamydia trachomatis in the US. Other bacteria known to cause reactive arthritis which are more common worldwide are Neisseria gonorrhoeae, Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter spp.^[2] A bout of food poisoning or a gastrointestinal infection may also trigger the disease (those last four genera of bacteria mentioned are enteriche arthritis that follows usually affects the large joints such as the knees causing pain and swelling with relative sparing of small joints such as the wrist and hand. The urethra, cervix and throat may be swabbed in an attempt to culture the causative organisms. Cultures may be carried out on urine and stool samples. Synovial fluid from an affected knee may be aspirated to look at the fluid under the microscope and for culture.

Also, a blood test for the gene HLA-B27 may be given to determine if the patient has the gene. About 75 percent of all patients with Reiter's Syndrome have the gene.

Eye involvement occurs in about 50% of men with urogenital reactive arthritis and about 75% of men with enteric reactive arthritis. Conjunctivitis and uveitis can include redness of the eyes, eye pain and irritation, or blurred vision .Reactive arthritis may be self limiting, frequently recurring, chronic or progressive. Most patients have severe symptoms lasting a few weeks to six months. 15 to 50 percent of cases have recurrent bouts of arthritis. Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases. Repeated attacks over many years are common, and more than 40 percent of the patients end up with chronic and disabling arthritis, heart disease, diabetes or impaired vision. However, most people with reactive arthritis can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved organs

"Drumstick?!"

"Drumstick?!"

Nobody should miss this sign - Clubbing
Clubbing is a common sign in clinical practice. It gives clue to the underlying disease.When clubbing is present, please demontrate nail bed fluctuation, palpate wrist for tenderness seen in HPOA, look for nicotine staining of nail and central cyanosis.

Rheumatoid Arthritis hand

Rheumatoid Arthritis

Hands for PACES"

Hands for PACES"

There are not many locomotor cases that the examiners can produce for PACES. So, please remember the following 3 classical locomotor cases.

RA hands: symmetrical deforming arthropathy with synovial thickening.

Psoriatic arthropathy: asymmetrical arthropathy involving terminal IPJ with nail changes.

Chronic tophaceous gout: asymmetrical deforming arthropathy with tophi formation.

marfan syndrome