Differential diagnoses to consider:
Ankylosing sponlylitis
- Any history of back pain, back stiffness
Reactive arthritis – post infection
- Ask about history of gastroenteritis, urethritis, conjunctivits
Gout
- History of similar joint pain, tophi, drug history
Enteropathic arthritis (with inflammatory bowel disease)
- Symptoms of IBD
Psoriatic arthropathy
- Rashes, nail changes
Rheumatoid arthritis
- Symmetrical involvement
Sjögren’s syndrome
- Dry eyes, xerostomia
Vasculitis
- Constituitional symptoms, painful skin lesions, neuropathy
Septic arthritis
- History of gonorrhoea (TRO gonococcal arthritis)
This patient actually has reactive arthritis, Reiter’s syndrome, characterized by triad of arthritis, conjunctivitis and urethritis. He had history of travelling to India 3 weeks before onset of symptoms and developed diarrhoea when he was there. Onset of reactive arthritis usually begins 2-6 weeks after an initiating infection at a distant site (dysentery / urethritis)
Investigations:
Inflammatory markers – ESR, CRP
Culture and sensitivity – Stool sample, sample from urogenital tract
Synovial fluid analysis – to exclude septic arthritis (failure to treat septic arthritis may result in joint destruction) and gout
Radiography of the affected joint
Treatment and management:
Pain relief with NSAIDs
Steroid
Referral to ophthalmology for conjuctivitis
Physiotherapy
No comments:
Post a Comment