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  #1  
Old 07-10-2011
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Rheumatology/Orthopedics Swollen Knee Joint + H/O Bloody Diarrhea

A 28-Yr-old male presents with chief complaint of knee pain. He also have mild back pain but knee pain is hurting more. He denies any trauma history. On examination knee joint is swollen and red. Past history is significant for bloody diarrhea but he is treated for that. ESR is 35mm/hr. Uric acid level is normal. Rheumatoid factor is negative. Synovial fluid analysis is normal. HLAB27 positive. Gram stain is normal. What could be the diagnosis?
1. Psoriatic arthrities
2. Rheumatoid arthrities
3. Rheumatic Fever
4. Reactive arthrities
5. Disseminated gonococcal infection
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  #2  
Old 07-10-2011
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Back Pain - young age,hlab27 + , hx of bloody diarhea , no trauma, - Rieters syndrome/ reacive arthritis

1- psoriatic has to have a proceeding hx of psoriasis or inc. in uric acid lvl

2-Rh factor was negative

3- this is a migratory polyarthritis u also need some symptoms like subcutaneos nodules eretem marginatum or a hx of recent throat infection.

5- no symptoms of GC ie rash pustules tenosynovitus
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Old 07-11-2011
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i m with 4. Reactive arthrities
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Old 07-11-2011
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My answer is 4 Reactive arthritis . He probably recently been infected with salmonella which makes him prone to have this episode. Since he is HBLA +
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Old 07-11-2011
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I thought the most common cause of reactive arthritis was compylobacter (which is also a cause of bloody diarhea)
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Old 07-11-2011
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Quote:
Originally Posted by docnas View Post
I thought the most common cause of reactive arthritis was compylobacter (which is also a cause of bloody diarhea)
any bacterium causing invasive diarrhea can cause it, campylobacter happens to be the most common.
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Old 07-11-2011
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Reactive Arthritis...campylobacter and i think e coli too
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Old 07-12-2011
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4. Reactive arthrities

bloody diarrhea due to coplybacter or IBD
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Old 07-12-2011
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Quote:
Originally Posted by confident View Post
A 28-Yr-old male presents with chief complaint of knee pain. He also have mild back pain but knee pain is hurting more. He denies any trauma history. On examination knee joint is swollen and red. Past history is significant for bloody diarrhea but he is treated for that. ESR is 35mm/hr. Uric acid level is normal. Rheumatoid factor is negative. Synovial fluid analysis is normal. HLAB27 positive. Gram stain is normal. What could be the diagnosis?
1. Psoriatic arthrities
2. Rheumatoid arthrities
3. Rheumatic Fever
4. Reactive arthrities
5. Disseminated gonococcal infection
Answer is 4. HLAB27 POSITIVE, git( chlamydia, salmonella) infection, arthrities, (circinate balanitis and keratoderma blennorrhagicum) rash seen, mostly wt bearing joints are involved.

1.Psoriatic is similar in rash and arthrities h/o but differentiated but here DIP are effected

2.here small joints are effected, poly joints are involved, rheumatoid factor should be positive

3. should have h/o sore throat and jones minor and major criteria is considered for diagnosis.

5. Here rash(painless maculopapular pustules) are found on extremity. Migratory arthrities and tenosynovities are seen. It will be mostly acute attack.
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  #10  
Old 07-20-2011
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Default HOw do i check my answer??

I THINK d reactive arthritis
esr is elevated in certain forms of arthritis
the Blood.D is treated(no longer infected)
RF -ve excluding Rheumatoid arthritis
the backpain also support the arthritis?/?
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