rheumatoid arthritis

1. Case 1
Presenter: Layla Almzraq

2. The Case
 An otherwise healthy 68 years old man.
 Complain of pain and swelling in the right knee.
 He doesn’t feel particularly ill.
 His temperature is 38.5 C.

3. Learning Objectives:
1. What additional information do you need to obtain from
this patient?
2. What aspects of physical examination are of particular
relevance in this case?
3. What additional diagnostic procedure would you perfume?
4. Suppose this patient has septic arthritis; which
microorganism could be responsible?
5. What would your treatment plan be?

4. Learning Objectives:
1. What additional information do you need to obtain from
this patient?
2. What aspects of physical examination are of particular
relevance in this case?
3. What additional diagnostic procedure would you perfume?
4. Suppose this patient has septic arthritis; which
microorganism could be responsible?
5. What would your treatment plan be?

5. Additional information
Is it one joint or more – mono versus poly arthritis?
 Is it acute or chronic?
 Is it recurrent?
 Does the pain localized or general?
 Does the pain radiate to other part of the body?
 Are there any aggravating or relieving factors?

6. Additional information
 Any associated inflammation (redness and
warmth)?
 Any associated medical condition such as: DM, liver
disease, and trauma?
 Any one in your family member have the same
complain or related condition?

7. Additional information
But in this case it
look possibly
septic arthritis.
We should ask
about trauma. And
ask of Recurrent
acute episodes
usually MCP joint
but can rarely
affect knee is gout
and if knee can be
pseudogout.
Because in this
case is one joint
involvement so, it
could be
traumatic, septic
arthritis or
psedogout.

8. Learning Objectives:
1. What additional information do you need to obtain from
this patient?
2. What aspects of physical examination are of particular
relevance in this case?
3. What additional diagnostic procedure would you perfume?
4. Suppose this patient has septic arthritis; which
microorganism could be responsible?
5. What would your treatment plan be?

9. Physical Examination
Looking
• Swelling ( bony or
fluid (effusion) or
synovial)
• Deformity
• Rash
• Muscle wasting
• Scars (surgery)
Feeling
• Kind of
swelling
• Warmth
• Tenderness
• Range of
motion, and
pain during
both active
and passive
movement
Moving

10. Physical Examination
 Search for other abnormalities in the body system such as
Alopecia
Eye redness
Mouth dryness/ulcers
Rales, effusions, murmurs, rubs
Motor strength, sensation
pustular rash and urethritis may indicate gonococcal arthritis
Peripheral pulses, bruits

11. Learning Objectives:
1. What additional information do you need to obtain from
this patient?
2. What aspects of physical examination are of particular
relevance in this case?
3. What additional diagnostic procedure would you perfume?
4. Suppose this patient has septic arthritis; which
microorganism could be responsible?
5. What would your treatment plan be?

12. Additional diagnostic procedure

13. Learning Objectives:
1. What additional information do you need to obtain from
this patient?
2. What aspects of physical examination are of particular
relevance in this case?
3. What additional diagnostic procedure would you perfume?
4. Suppose this patient has septic arthritis; which
microorganism could be responsible?
5. What would your treatment plan be?

14. Microorganism could be responsible of septic
arthritis
• The organism that most commonly causes septic arthritis is
Staphylococcus aureus.
• Other organisms include streptococci, other species of
staphylococcus, Neisseria gonorrhoeae
• Haemphilus influenzae in children
• Other Gram-negative organisms in the elderly or
complicating Rheumatoid arthritis

15. Learning Objectives:
1. What additional information do you need to obtain from
this patient?
2. What aspects of physical examination are of particular
relevance in this case?
3. What additional diagnostic procedure would you perfume?
4. Suppose this patient has septic arthritis; which
microorganism could be responsible?
5. What would your treatment plan be?

16. Treatment
• The goal of therapy:
Control pain and swelling
Prevent deformities and limitation
I.V Antibiotics for 2 weeks
Specific antibiotics (2 antibiotics) for 6
weeks:
I.V Flucloxacillin 2g given 6 hourly +
Sodium Fusidate 500 mg orally 8-
hourly
Drainage & arthroscopic joint washouts
(helpful in relieving pain)

17. References
• Kumar and Clark's clinical medicine 9th Edition. Chapter 18

18. Thank you
