MOFFITT AM REPORT PEARLS 9/2/16: Gonococcal Arthritis!

**Top pearls:

  • Gonococcal arthritis can present as migratory polyarthralgia or tenosynovitis and usually involves multiple joints asymmetrically.
  • Due to emerging resistance of gonorrhea to ceftriaxone, azithromycin is recommended not only for empiric treatment of chlamydia but also to treat resistant gonorrhea!

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For those interested in more info:

 

Disseminated gonococcal infection (DGI)

Features:

  • 70% migratory polyarthralgia: small or large joints, usually asymmetric
  • 67% tenosynovitis: polyarticular wrist, fingers, ankles, toes
  • 67% dermatitis: typically painless lesions, usually pustular/vesicular but can see macules/papules/bullae/nodules too!
  • 63% fever
  • Can also have purulent arthritis, either mono or polyarticular
  • Only 25% have GU sx!

Diagnosis:

  • Blood cultures are useful
  • Swab mucosal sites for DNA testing or culture (urine is slightly lower sensitivity than vaginal/cervical swab in women but equal to urethral swab in men)
  • Tap involved joint if possible
  • Skin lesion yield is low!
  • Test for other STIs!

Treatment:

  • Ceftriaxone 1g IV or IM every 24 hrs + azithromycin 1 g PO single dose
  • Duration is 7-14 days
  • Contact and treat sexual partners!

 

 

Arthritis ddx

Monoarthritis:

  • Infection (Staph, GC)
  • Crystalline
  • Rheum disease (RA, SLE, sarcoid, spondy)
  • Inflammatory osteoarthritis
  • Trauma/Hemarthrosis
  • Tumor (giant cell tumor, sarcoma, metastasis)

Oligo/polyarthritis (some overlap with monoarthritis!):

  • Infection (Lyme, endocarditis, viral)
  • Crystalline
  • Rheum disease (RA, SLE, sarcoid, spondy, psoriatic, IBD, poly/dermatomyositis, vasculitis)
  • Inflammatory osteoarthritis
  • Post-infectious/reactive
  • Other systemic disease: FMF, malignancy

 

 

Approach to Inflammatory Arthropathies (from Br J Hosp Med 2016):

Pic

Evernote: https://www.evernote.com/shard/s272/sh/74c65a5d-3c39-41a5-a6cf-439383dece12/5cbbef4a2e333a759945a9efbeb94b44

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