Download 3. What is your Initial Impression and give your Differential Diagnosis.

3. What is your Initial Impression
and give your Differential
Diagnosis.
3. What is your Initial
Impression?
Patient:
Immunocompromised
ill looking
Fever and chills
Left Knee:
+ trauma
Abrupt in onset
< 2weeks (acute)
Unilateral pain and
swelling, warm
Limited range of
motion
SEPTIC ARTHRITIS
probably bacterial
infection
SEPTIC ARTHRITIS
 Occurs as a result of hematogenous seeding
of infectious organism in the synovial fluid
 Consequence of inflammatory reaction
 joint cartilage and synovial are damage by the
proteolytic enzymes and mechanical factors.
 Common in young children
SEPTIC ARTHRITIS
 Etiologic Agent:
 Staphylococcus aureus (most common)
 Gonococcal (sexually active)
 Candida (disseminated infection)
 Viral (systemic infection)
SEPTIC ARTHRITIS
 Infection of joints are followed by Penetrating
injuries:
 Trauma
 Arthroscopy
 Prosthetic Joint Surgery
 Intra-articular Steroid Injection
 Orthopedic Surgery
Differential Diagnosis
 Juvenile Rheumatoid Arthritis
 Onset < 16 y/o
 Persistent arthritis in at least one joint for 6 weeks
 polyarticular course and functional disability
 symmetric, large and small joints
 Exclusion for other diagnoses
 Girls > boys
 production of JRA – causes synovial
inflammation, bone erosion, fever, rash, joint
destruction; can be treated with biologic agents
Differential Diagnosis
 Systemic Lupus Erythematosus
 An episodic, multisystem, autoimmune disease
 Widespread inflammation of blood vessels and
connective tissues
 Intermittent Polyarthritis
 Mild from disabling
 Characterized by soft tissue swelling and
tenderness in joints of the hands, wrist, and knees
 Presence of autoantibodies (hallmark of SLE)
Differential Diagnosis
 Drug induced:
 Glucocorticoid treatment
 Can cause osteopenia and osteonecrosis
 Hydrochloroquine
 Can cause osteonecrosis