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ACUTE MONOARTHRITIS BERGER’S B’S

ACUTE MONOARTHRITIS BERGER’S B’S. BUGS BLOOD BIREFRIGENCE. CALCIUM PYROPHOSPHATE (cppd). Acute pseudogout Female predominant Knees/Shoulders/Wrists/MCP’s High fever and sed rate possible Can coexist in same joint with true infectious etiology: Unlike gout. CALCIUM HYDROXYAPATITE.

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ACUTE MONOARTHRITIS BERGER’S B’S

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  1. ACUTE MONOARTHRITISBERGER’S B’S • BUGS • BLOOD • BIREFRIGENCE

  2. CALCIUM PYROPHOSPHATE (cppd) • Acute pseudogout • Female predominant • Knees/Shoulders/Wrists/MCP’s • High fever and sed rate possible • Can coexist in same joint with true infectious etiology: Unlike gout

  3. CALCIUM HYDROXYAPATITE • “Milwaukee Shoulder” • Shoulders/knees/hips • Hemarthrosis associated • Rotator cuff destruction • Fever and high sed rate less common than in CPPD

  4. Musculoskeletal Presentations of Infectious Diseases • Known systemic infectious diseases with musculoskeletal presentations • Probable infectious agent causing systemic rheumatic disease

  5. Post Streptococcal Arthritis(Rheumatic Fever) • Shoulder “periarthritis” (80% in Persellin series in 1970’s) • Classical migratory large joint synovitis rare • Nodules/Carditis/Athetosis rare • E nodosum more common than E marginatum

  6. Gonorrhea • Monoarticular/Pauciarticular synovitis: Large joint predominance • Recovery of organism from joint 10% or less. Smears negative • When recovered from joint, Rx the same as Staph septic joint: Recurrent aspirations

  7. KAWASAKI DISEASE • Fever lasting at least 5 days • Bilateral conjunctivitis • Oral mucous membrane changes • Peripheral extremity changes • Polymorphus rash • Cervical lymphadenopathy • Lab markers of inflammation

  8. KAWASAKI DISEASE • Inflammatory Arthritis: 15-25 % • Diarrhea/Abd pain: 50% • Cough: 35 % • CORONARY ARTERITIS WITH ANEURYSMS: ? 100% ACUTELY • IVIG AND ASA!!!

  9. Parvovirus: B19 • Rheumatoid Arthritis look alike: Symmetrical Polyarthritis involving hands/wrists/knees/feet • + RF and ANA 20-30% • + cryoglobulins • 6 month course • Steroids occasionally required

  10. HEPATITIS B • Symmetrical polyarthritis:small joints • Sometimes Urticarial rash • Prodrome to jaundice • Low serum complements • Sometimes with glomerulonephritis

  11. RUBELLA • Large joint oligoarthropathy almost always involving knees • Can last months • Chronic RA look alike described after initial infection • Can occur after immunizations

  12. LYME DISEASE • True arthritis tertiary manifestation • Arthralgia common in secondary stage • Pauciarticular large joint arthopathy • Thought intially to be JRA • One mother and local PTA + YALE

  13. REACTIVE ARTHRITIS SYNDROME • 90% with preceding chlamydial infection vs. bowel pathogen • Also described after Chlamydia Pneumonia and Mycoplasma Pneumonia • Chlamydial antigen demonstrated in synovium in involved joints • ?? Controls • ?? Immunological mechanism

  14. LOFGRENS SYNDROME • Acute Histoplasmosis/Sarcoidosis • Fever • Erythema Nodosum • Ankle Periarthritis • Hilar Adenopathy • Occasional uveitis/parotitis • Usually resolves without sequelae

  15. GIANT CELL ARTERITIS • Temporal /Takayasu’s arteritis • Old Scandinavian women vs. young Japanese/Israeli/Mexican women • Carotid vs. aortic arch circulation • Systemic symptoms: FUO presentation • Symmetrical polyarthritis: 10% • Sed rates!!!!!!!! • Parvovirus anectdotes: Mayo data

  16. BEHCET’S SYNDROME • Painful oral and genital ulcers • Uveitis: Anterior and posterior • “Pathergic” skin rash • Aseptic meningitis • Hypercoaguability • Pulmonary arterial aneurysms • TNF excess: Therapeutic options

  17. Relapsing Polychondritis • True cause of ER Dx of costochondritis • Chondritis/scleritis/vasculitis • Fever and arthritis • Palpable purpura • Subglottic stenosis • Tracheal collapse • Rx with steroids and immunosuppresion

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