- diet modification 1. NSAID 2. Colchicine 3. Corticosteroid 4. Interleukin 1 beta inhibition (anakinra)

Gout, Psuedogout, FM, Raynaud Flashcards by Linda Ung

What is the pathophys of gout?

result of deposition of uric acid crystals in joint tissues and fluid within body/joints

hyperuricemia –> inflammtion –> destruciton

How well did you know this?

Not at all

Perfectly

Is hyperuricemia the same as gout?

How well did you know this?

Not at all

Perfectly

Pt labs reveals hyperuricemia but is not experiencing any symptoms. Does this pt need to be treated?

How well did you know this?

Not at all

Perfectly

Non modifiable risk factors for gout

male
african america
adv age
pacific islander

How well did you know this?

Not at all

Perfectly

Modifiable risk factors for gout

Alcohol and high purine food ingestion
Obesity
HTN
Diuretic use--HCTZ
Toxic exposure--lead

How well did you know this?

Not at all

Perfectly

What is the relation between GOUT and MI?

Gout can increase risk of MI

How well did you know this?

Not at all

Perfectly

What pt population is gout most commonly seen in?

Men
Women after menopause
Pt w/ kidney dz

How well did you know this?

Not at all

Perfectly

What comorbidities is gout strongly linked to

Obesity
HTN
Hyperlipidemia
DM

How well did you know this?

Not at all

Perfectly

What are the 3 causes of gout?

inherited (primary)
acquired (secondary)
unclear etiology

How well did you know this?

Not at all

Perfectly

Do gout pt mostly present as overproducers or underexcreters?

Underexcreters

How well did you know this?

Not at all

Perfectly

What are etiologies of underexcretion?

Causes increase level of uric acid in blood

primary hyperuricemia (genetic factors)
dehydration (acquired)
Renal insuff and decrease GFR (renal disorder)
Keto or lactic acidosis (endogenous)
Low dose ASA, thiazides, BB, nicotonic acid (exogenous)
Lead nephropathy

How well did you know this?

Not at all

Perfectly

What are etiologies of over production?

Excessive dietary intake (red meat, organ meat, shellfish)
Alcoholic bevagerages (esp beer)
Leukemia
Hemolytic anemia
Psoriasis
Exercise (severe dehydration)
Fructose ingestion

How well did you know this?

Not at all

Perfectly

Presentation of gout

Acute onset
Joint swellling usu in 1 joint, can be polyarticualr
Extremely tender
Redness
1/2 Podagra (MTP great toe)
Renal (uric acid stones, gouty nephritis)

How well did you know this?

Not at all

Perfectly

What areas of the body is gout most likely to present

Feet
Ankles
Knee

How well did you know this?

Not at all

Perfectly

Acute gout presents as…?

PODAGRA
monoarticular arthritis (can be polyarticular)
skin warm, tense, dusky red

How well did you know this?

Not at all

Perfectly

Chronic gout presents as….?

TOPHI
Deposits urate crystals
Drainage
CT destruction, gross deformity
Injection
bone destruction or erosion

FUNCTION LOSS

How well did you know this?

Not at all

Perfectly

1 diagnostic tool for gout

Arthrocentesis

How well did you know this?

Not at all

Perfectly

What should you be looking for in an arthrocentesis for gout?

Intra cellualr uric acid crystals

needle shaped
yellow when parallel

How well did you know this?

Not at all

Perfectly

Are there birefringence under polarized light microscopy in a arthrocentesis of gout?

NO–negative

How well did you know this?

Not at all

Perfectly

What other diagnostic tools should you get for gout

Hint: r/o septic joint

Gram stain and culture

How well did you know this?

Not at all

Perfectly

24hr urine reveals increase level of uric acid. Is this pt a overproducer or underexcreter?

Overproducer

Underexcreters will have increase level of uric acid in the BLOOD

How well did you know this?

Not at all

Perfectly

Should you rely on a increase serum uric acid >6.8 to diagnose gout?

No. can be misleading and not diagnostic

How well did you know this?

Not at all

Perfectly

Acute gout Tx

Study These Flashcards

diet modification
1. NSAID
2. Colchicine
3. Corticosteroid
4. Interleukin 1 beta inhibition (anakinra)

How soon should you initiate acute gout tx?

Study These Flashcards

within 24hrs

How soon after an acute therapy should you start chronic tx?

2-4wks after acute attack | then recheck uric acid lvl

``` Which NSAID is best to tx gout? A. naproxen B. ibruprofen C. diclofenac D. indomethacin ```

D. Indomethacin

Tachaceous deposits is a sign of what? (Chronic or acute?

Chronic gout

Another name for psuedogout

Chrondocalcinosis

What joint is psuedogout most commonly seen?

In the knee

What is being deposited in psuedogout?

Ca++ pryophosphate dehydration (CPPD)

Which of the following is not a risk factor for psuedogout? A. age B. diabetes C. hyperparathyroidism D. trauma

B. diabetes

Presentation of psuedogout

- acute - can be asymptomatic - mono or poly articular - can resolve on their own after few days or 2wks - often co-exist w/ osteoarthritis - FEVER POSSIBLE - red warm, tender, sweollen - VALGUS deformity of knee

Diagnostic criteria of psuedogout

CPPD crystals synovial fluid CPPD crystal deposits elevated ESR/CRP

Does psudogout have birefringents?

YES--positive

What can you see on imaging for psuedogout?

Joint cartilage calcified and calcium deposits in joint spaces Chondrocalcinosis

Acute tx psuedogout

``` NSAIDs Colchicine Steroids Drain fluid Rest Ice ```

What is considered chronic psuedogout

>3 attacks per yr

How would you tx chronic pseudogout?

1st Colchicine 2nd NSAID Tx underlying condition if metabolic dz

What does CREST syndrome stand for?

``` Calcinosis Raynaud Esophageal dysmotility Sclerodactyly (thickening of skin) Telangiectasia ```

Definition of Raynaud's Phenomenon

Abrupt onset of well-demarcated pallor of digits which progresses to cyanosis w/ pain and often numbness--followed by reactive hyperemia on rewarming

What can trigger Raynaud's?

``` Cold exposure Stress Use of BB Ergotamine preparation Polyvinyl chloride Some chemo agents Hand-arm vibration syndromes (vibratory tools) ```

Primary Raynaud

Not assoc w/ any underlying cause | Physical exam normal between attacks

Secondary Raynaud

Assoc w/ or caused by some other systemic illness or dz process (ex SLE) Pits or ulcerations on fingertips may be present in pt w/ scleroderma, CREST syndrome, or thromboangiitis obliterans

Does Raynaud present unilateral or bilaterally?

Bilaterally!

What are the most effective pharmacologic agents to tx Raynaud

Dihydropyridine CCB (Amlodipine and NIfedipine)

Non pharm therapies for Raynaud

- use mittens instead of gloves - careful when handling cold objects - smoking cessation - avoid BB

What is allodynia and what is it associated with?

Allodynia = pain d/t stimulus which does not normally provoke pain Assoc w/ Fibromyalgia

What pt population is fibromyalgia (FM) most commonly seen in?

Women age 20-50

Presentation of FM

- Widespread pain, multiple tender points - Worse in AM and before bed and w/ cold, stress and new exercises - stiffness - SENSATION of swelling - fatigue - difficulty sleeping - hx of DEPRESSION - psychological and neuropsych sx NO swelling and NO erythema

Dx criteria of FM

Generalized body pain for at least 3 mo | At least 11 out of 18 specific tender points

What labs can you do to help you towards your dx of FM?

CBC--r/o infection H&H--r/o anemia (cause of fatigue/joint point) Vit D lvl r/o cause of fatigue TSH--r/o hypo-T as cause of fatigue, malaise and arthralgia Sleep Study

What are the 1st line pharmacologic agents used for FM?

Tylenol or Tramadol

2nd line pharm agents for FM?

Tricyclic Antidepressants

What are non-pharm therapies for FM?

* Cognitive behavior techniques * Exercise Acupuncture Massage Chiropractic

Should an pt newly diagnosed with FM stop exercising?

NO. If increased pain after exercise, modify work out--do not stop!

A construction worker who often uses chain saws and pneumatic hammers presents with well-demarcated pallor of digits when exposed to cold. Based on the pt's diagnosis, what therapy would be most effective for them? A. Propanolol B. Hydroxychloroquine C. Nifedipine D. Prednisone

C. Nifedipine CCB work best (Amlodipine or Nifedipine) BB may exaggerate sx

What pharm therapy should you try 1st in a pt w/ newly diagnosed gout?

NSAID *try colchicine 2nd

Gout, Psuedogout, FM, Raynaud Flashcards

(57 cards)