Arthritis and Gout

Question 1

Oligo-articular involves how many joints?

Answer 1

2-4

Question 2

Poly-articular involves how many joints?

Answer 2

> 5

Question 3

red, swelling, heat, pain are indicative of

Answer 3

joint inflammation

Question 4

(inflammatory/non-inflammatory) joint pain is WORSE in the morning, but IMPROVES with activity

Answer 4

Inflammatory (septic, RA, gout, SLE)

Question 5

(inflammatory/non-inflammatory) joint pain is okay in the morning, but WORSENS with activity

Answer 5

Non-inflammatory (osteoarthritis, trauma)

Question 6

ACUTE monoarthritis can be indicative of

Answer 6

Septic arthritis

Gout

Question 7

Arthrocentesis is aka

Answer 7

joint aspiration

Question 8

(lightly cloudy/tea/white) colored synovial fluid is indicative of osteoarthritis

Answer 8

lightly cloudy

Question 9

(cloudy/tea/white) colored synovial fluid is indicative of inflammatory arthritis

Answer 9

Tea

Question 10

(cloudy/tea/white) colored synovial fluid is indicative of septic arthritis

Answer 10

White

Question 11

Gout as a monoarthritis most often involves 1st

Answer 11

MTP joint

Question 12

Joint pain due to loss of normal articular cartilage with age, trauma, and obesity; pain worsens with activity; associated with popliteal cysts, DIP/PIP joints and 1st CMC joint

Answer 12

Osteoarthritis

Question 13

X-ray characteristics of Osteoarthritis

Answer 13

1. Osteophytes (bony lumps on vertebrae)

2. Joint space narrowing (wearing of joint cartilage)

Question 14

The crystal involved with Gout is

Answer 14

Monosodium Urate Crystals (needle shaped and strongly negatively birefringent)

Question 15

Acute monoarthritis due to deposition of monosodium urate crystals in the joints; more common in men; Hyperuricemia is ESSENTIAL for the development

Answer 15

Gout

Question 16

Obesity, diabetes, alcohol and some medications (aspirin, diuretics, etc.) are the risk factors for

Answer 16

Gout

Question 17

Hyperuricemia causing Gout is majorly due to (overproduction/under-excretion) of uric acid

Answer 17

underexcretion

Question 18

Hyperuricemia is defined as a serum urate level…

Answer 18

> 7 mg/dL

Question 19

Acute monoarthritis in Gout usually involves which joint?

Answer 19

1st MTP

Question 20

Nodular masses of uric acid crystals deposited in different soft tissue areas of the body; most commonly at the fingers, at the tips of the elbows, and around the big toe

Answer 20

Tophus gout (chronic)

Question 21

Synovial fluid analysis is the ONLY definitive diagnosis for Gout as it will be inflammatory (>5k WBCs) (True or False)

Answer 21

True

Question 22

What characteristics of synovial fluid will indicate Gout

Answer 22

WBC >5k

+ Urate crystals (under polarized light)

Question 23

Treatments for Gout

Answer 23

Acute: NSAIDs, steroids, colchicine

Chronic (preventative): Allopurinol (xanthine oxidase inhibitor)

Question 24

Function of colchicine

Answer 24

Inhibits tubulin in microtubules –> inhibits neutrophil fx

Doesn’t alter urate levels though!!

Question 25

Pentose phosphate Pathway produces what byproducts?

Answer 25

1. Ribose-5-Phosphate | 2. PRPP

Question 26

What is the major regulating step for purine synthesis and its enzyme?

Answer 26

Conversion of PRPP --> 5-phosphoribosyl 1-amine * GPA (Glutamine Phosphoribosyl Amidotransferase)

Question 27

Examples of Xanthine Oxidase Inhibitors

Answer 27

Allopurinol | Febuxostat

Question 28

Adenine, Hypoxanthine, and Guanine are purine bases that all require what in the salvage pathway to make nucleotides?

Answer 28

PRPP

Question 29

Adenine uses APRT to make AMP, while Hypoxanthine and Guanine use _____ to make IMP, GMP

Answer 29

HGPRT

Question 30

Glucose 6-phosphatase deficiency, lesch-nyhan syndrome, tumor lysis syndrome, PRPP excess, and von gierke disease (type I glycogen storage disease) can cause hyperuricemia through

Answer 30

Overproduction of uric acid

Question 31

X-linked recessive; HGPRT deficiency disorder; buildup of Hypoxanthine and Guanine --> degradation into uric acid

Answer 31

Lesch-Nyhan Syndrome

Question 32

the destruction of tumor cells releases tons of nucleic acids, stimulating degradation and uric acid production

Answer 32

Tumor Lysis Syndrome

Question 33

In excessive alcohol consumption and type 2 diabetes, excess lactic acid production competes with _____ leading to Gout

Answer 33

uric acid

Question 34

"Pseudogout"; deposition of Calcium Pyrophosphate crystals in joints; rhomboids/pleomorphic, weakly + birefringent; more knee involvement (vs. MTP in gout)

Answer 34

Calcium Pyrophosphate Deposition (CPPD)

Question 35

aging and metabolic disturbances (Hyperparathyroidism, Hemochromatosis/iron overload) are risk factors of

Answer 35

CPPD

Question 36

Tx for CPPD

Answer 36

NSAIDs Steroids Colchicine * same as acute gout

Question 37

A chronic autoimmune inflammatory disease; SYMMETRIC inflammatory POLYarthritis affecting proximal small joints in hand/foot; mediated by macrophages, cytokines, and MMPs; women are affected more; associated with HLA-DRB1 gene, Parvo/EBV viruses

Answer 37

Rheumatoid Arthritis

Question 38

Gene associated with Rheumatoid Arthritis

Answer 38

HLA-DRB1 gene

Question 39

Cytokine important for Rheumatoid Arthritis; produced mainly by MONOCYTES and MACROPHAGES

Answer 39

TNF-a

Question 40

Rheumatoid arthritis usually involves (proximal/distal) hand and foot joints

Answer 40

Proximal (wrist, MCP, ankle, and MTP joints)

Question 41

Osteoarthritis usually involves (proximal/distal) hand and foot joints

Answer 41

Distal (PIP, DIP) * exception 1st CMC joint

Question 42

What are some other organ complications of RA?

Answer 42

1. CAD (cardiology) 2. Nodules (dermatology) 3. Interstitial lung disease 4. Sjogren's syndrome (decreased tear and salivary production)

Question 43

Common autoantibodies for Rheumatoid Arthritis

Answer 43

1. Rheumatoid factor 2. anti-cyclic citrullinated protein (anti-CCP) antibody * anti-CCP is most specific diagnosing antibody

Question 44

an antibody against the Fc portion of IgG

Answer 44

Rheumatoid Factor (anti-IgG antibody)

Question 45

Radiographic features of Rheumatoid Arthritis

Answer 45

1. Periarticular osteopenia 2. Joint space narrowing 3. Erosion of bone (looks spongy)

Question 46

Treatments for Rheumatoid Arthritis

Answer 46

Disease-modifying agents (Methotrexate) Biologics (TNF-a inhibitors--> Adalimumab) Corticosteroids (short-term)

Question 47

A group of arthritis without rheumatoid factor; includes PAIR; associated with HLA-B27 gene

Answer 47

"Seronegative" Spondyloarthritis Antibodies NOT detected

Question 48

PAIR include what types of arthritis

Answer 48

Psoriatic arthritis Ankylosing spondylitis IBD (UC/chron's) Reactive arthritis

Question 49

Common signs/symptoms of Seronegative Spondyloarthritis

Answer 49

1. Back pain 2. Peripheral arthritis 3. Enthesitis (inflammation of tendons--> achilles) 4. sausage fingers

Question 50

Gene associated with PAIR arthritis

Answer 50

HLA-B27

Question 51

Arthritis associated with psoriasis; nail lesions (onycholysis)

Answer 51

Psoriatic Arthritis

Question 52

Arthritis associated with fusion of SI joints and vertebrae; bamboo spine on x-ray; more in males

Answer 52

Ankylosing Spondylitis

Question 53

Arthritis associated with Inflammatory Bowel Diseases; usually presents with GI symptoms + skin symptoms

Answer 53

Enteropathic Arthritis

Question 54

Arthritis associated with triad (conjunctivitis, Urethritis, Arthritis); follows a recent bacterial infection (yersinia/chlamydia/salmonella)

Answer 54

Reactive Arthritis Can't see, can't pee, can't bend my knee

Question 55

What virus has been implicated in RA and SLE (both are autoimmune disorders)?

Answer 55

Parvo B19

Question 56

Osteoarthritis will involve (bony/spongy) enlargements of joints while Rheumatoid Arthritis will involve (bony/spongy) enlargements

Answer 56

OA: bony RA: spongy