Clinical impression septic arthritis：化脓性关节炎的临床印象.pptVIP

* Clinical impression septic arthritis Patient Presents With Acute Increase In Pain +/- Swelling In One Or More Joints G.P Refer for urgent AE or specialist assessment Definite alternative diagnosis Inflammatory arthritis Crystal arthritis Haemarthrosis Trauma Bursitis/Cellulitis Treat as appropriate No definite alternative diagnosis but could be septic Self referral to AE MUST ASPIRATE and other investigations History Examination History Examination Diagnosis SEPTIC ARTHRITIS Empirical antibiotic treatment (as per local protocol) Alter if necessary once results available NOT SEPTIC Seek rheumatology or orthopaedic advice if in doubt HISTORY Joint Pain Joint Swelling – recent increase (symptoms often present for 2 weeks in septic arthritis) Note that in presence of pre-existing inflammatory joint disease the symptoms in the affected joint are out of proportion to the disease activity detected in other joints. Systemic symptoms – e.g. fever, sweats, rigors, confusion Factors predisposing to sepsis - trauma, recent local infection or septicaemia, i.v. drug abuse, recent invasive procedure, pre-existing joint disease including prosthetic joints, Drugs Steroids and Immunosuppressants - including previous intra-articular joint injections - could predispose to infection Antibiotic treatment - sepsis may have been partially treated Alternative Diagnoses - history of psoriasis, inflammatory bowel disease or iritis would suggest seronegative spondyloarthritis - crystal arthritis is suggested by a history of previous gout affecting the great toe - consider haemarthrosis if there is a history of haemophilia or significant trauma - drugs, thiazides can predispose to crystal arthropathy especially in elderly women Examination EXAMINATION Joint Effusion / heat / erythema / restriction of movement - if all 4 signs are present then sepsis is likely Large joints more commonly affected than small joi