Gout, Pseudogout, and Lupus diagnosis and treatments

Question 1

What are three differential diagnoses for acute monoarticular athritis?

Answer 1

Septic joint caused by gonococcal bacterium (younger age groups), nongonococcal bacterium (#1 is staph aureus, these are the most destructive types), or crystalizing arthritis (gout or pseudogout)

Question 2

What is the primary drug of choice for prevention for someone who is an over-producer of uric acid?

Answer 2

AllOPurinol (OP=over producer), Febuxostat is a new and $$$$ drug that is easier on renal function

Question 3

What is the primary drug of choice for someone who is an under-excreter of uric acid?

Answer 3

Probenecid (watch dosing)

Question 4

What is the gold standard for gout diagnosis? What does it reveal?

Answer 4

arthrocentesis (r/o infectious cause), reveals negatively birefringent monosodium urate crystals

Question 5

How is a serum acid level used in the treatment of gout?

Answer 5

levels are high in 95% of people with gout (highly specific), but only 15-20% of patients with high serum acid levels will develop gout

Question 6

What radiographic finding is present in gout?

Answer 6

“rat bite” appearance signifying joint erosion

Question 7

What levels of uric acid are needed to treat asymptomatic gout?

Answer 7

> 11mg/dL

Question 8

What three stages is gout treated in?

Answer 8

1) treatment of acute attack 2) prophylaxis to prevent future flares 3) elimination of excess stores

Question 9

What is the first line treatment of an acute gout attack in an otherwise healthy patient?

Answer 9

Indomethacin– MANY SIDE EFFECTS

Question 10

What is the second line treatment for an acute gout episode?

Answer 10

intra-articular steroid injections (make sure infection is r/o)

Question 11

How is Colchicine used for gout?

Answer 11

As a prevention, sometimes as a second line treatment IN A LOW DOSE

Question 12

What crystals are involved in pseudogout?

Answer 12

Calcium pyrophosphate dihydrate (positively birefringent)

Question 13

What age group is most susceptible to pseudogout?

Answer 13

The elderly

Question 14

What is the clinical presentation of gout?

Answer 14

acute onset of erythema, pain, and swelling in the large joints (knees are 50%)

Question 15

What is the primary treatment for pseudogout?

Answer 15

symptomatic with NSAIDs, ice, and steroid injections, Colchicine (+/- in elderly)

Question 16

What is the best differentiation between gout and pseudogout?

Answer 16

Gout is primarily in men over age 30 and postmenopausal women, primarily big toe. Pseudogout is primarily in the elderly, primarily knee.

Question 17

What are the two most common clinical presentations of lupus?

Answer 17

Malar (butterfly rash) or Discoid (erythematous patch with keratotic scaling in sun-exposed areas)

Question 18

What are some other clinical manifestations of lupus?

Answer 18

Non-specific fever, wt loss, anemia, RAYNAUD’S PHENOM (white, blue, red), recurrent fetal loss

Question 19

What two tests should a PA order to diagnose lupus?

Answer 19

ESR and ANA (in 95% of people with SLE)

Question 20

You get a positive ANA. Which one (of the three tests should a rheumatologist order to diagnose lupus) should be ordered first?

Answer 20

1) Anti-ds-DNA or anti-Smith antibodies, anti-phospholipid antibodies is alternate

Question 21

What is the treatment for lupus?

Answer 21

Dependent on severity of dz.
For lupus nephritis: cyclophosphamide and methylprednisolone
For CNS involvement: antipsychotics and anticonvulsants
For thrombocytopenia: corticosteroids and Igs
For antiphospholipids: warfarin and heparin or ASA for anticoag

Question 22

What lab test is unique for drug-induced lupus?

Answer 22

anti-histone antibodies, d/c drug and use steroids to treat

Question 23

What are the clinical presentations of Sjorgen’s Syndrome?

Answer 23

dry eye and dry mouth, recurrent parotiditis, some arthralgias

Question 24

What labs will be positive in Sjorgen’s Syndrome?

Answer 24

RF, ANA, normocytic normochromic anemia

Question 25

How will a rheumatologist treat Sjorgen’s Syndrome?

Answer 25

Artificial tears (cyclosporin), NSAIDs, Immunosuppressive agents

Question 26

What are the names for generalized autoimmune disorders that affect the connective tissue cutaneously and viscerally (respectively)?

Answer 26

Scleroderma and systemic sclerosis

Question 27

What does CREST stand for and what disease is it indicative of?

Answer 27

Calcinosis cutis, Raynaud’s phenom, Esophageal motility, Sclerodactyly, Teleangiectasias; scleroderma

Question 28

What lab tests may be positive in scleroderma?

Answer 28

ANA, ACA (anti-centromere),

Question 29

What is the primary treatment for Raynaud’s phenom?

Answer 29

CCBlockers

Question 30

What treatments are used in esophageal disease in scleroderma?

Answer 30

H2 blockers, proton pump inhibitors, and small, frequent meals.

Question 31

What drugs are used to treat renal disease in scleroderma?

Answer 31

ACE inhibitors (treat aggressively)