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Flashcards in Joint Pain Deck (30):
1

Substances that can exacerbate gout

large meal with purines (red meat, liver, nuts, seafood)
increase in alcohol consumption
THIAZIDE diuertics, loop diuretics
chemotherapeutic agents

2

How to diagnose goat

joint aspirate!

polarizing microscopy of fluid must reveal monosodiumurate (MSU) crystals that have strong NEGATIVE BIREFRINGENCE

3

Difference between gout and septic joint

WBC in aspirate is normal value for gout, but elevated in septic joint (avg 100,000) with 90% neutrophil dominance

4

gouty arthritis

excess uric acid which leads to crystal deposition in joints

5

Difference between gout and PSEUDOgoat

gout - MSU crystals that have negative birefringence
pseudogout - calcium pyrophosphate dehydrate CPPD crystals that are POSITIVE berefringence

6

Ddx to consider for nontraumatic swollen joint

gout, (or any crystal induced arthritis), infectious arthritis, osteoarthritis, rheumatoid arthritis

7

Typical first episode of gout

swelling and pain, usually of one joint, accompanied by erythema and warmth...can be easily confused with cellulitis

8

Classically, a gout attack usually involves _______ joint of ______ toe called _______

metatarsophalangeal joint of first toe, called podagra

9

T/F: Uric acid level is always elevated during a gout attack

FALSE. may be normal/low

10

Radiographic changes in the joint can show

cystic changes in the joint surface, punched out lesions and soft-tissue calcifications (non specific)

11

An infection usually involves __#___ joint(s) if bacterial in origin

1

12

What kinds of organisms can invade joints?

bacteria (i.e. gonoccal infections), fungi, mycobacteria

13

3 ways microbes can inject joints

1. direct penetration (surgery, bite, trauma)
2. hematogenous spread from distant infection
3. extension from nearby infected joint

14

How to evaluate joint suspicious for infection

- arthrocentesis and examination of synovial fluid
- blood culture, Gram stain and culture
- CBC, ESR

15

Risk factors for infectious arthritis

alcoholism, DM, HIV, malignancy, hemodialysis (HD), IV drugs, chronic med conditions

16

ROM for septic joint

VERY LIMITED due to pain; will also have joint effusion and fever

17

Typical presentation of osteoarthritis

Elderly, obese (>65) dull, deep, achey pain.
gradual onset, made worse with activity and better with rest; pain constant in later stages

18

What can be felt on physical exam for osteoarthritis

crepitus with passive ROM

19

How do xrays look for osteoarthritis

initially NORMAL then slowly gets bone sclerosis, subchondral cysts, and OSTEOPHYTES (not present in RA)

20

Which joints does RA typically affect most commonly

joints of hands (PIP, MCP) and wrists!!!
also can affect any other joints

21

Symptoms of RA

- MORNING STIFFNESS, improves as day progresses
- fever, fatigue
- C1-C2 subluxation
- subcutaneous rheumatoid nodules over extensor surfaces (PATHGNMONIC)

22

Abnormal labs in RA

- positive rheumatoid factor RF, positive anti-CCP
- elevated ESR and CRP
- anemia
- thrombocytosis and low albumin

23

RA affects which part of the joint

the synovium (synovitis)

24

Acute treatment of gout attack

colchicines, NSAIDS, and glucocorticoids, ice packs

25

Maintenance therapy for gout

allopurinol (decreases uric acid production)
probenecid (increases excretion of uric acid)

26

Treatment for septic arthritis

IV antibiotics and surgery for drainage of infected joint (usu vanc, but do culture to know what you're dealing with)

27

First line agent for RA treatment

DMARD (disease modifying antirheumatic drugs)

METHOTREXATE AND SULFASALZINE

28

When to do surgery for joint disease

last resort when medication and physical therapy fail

29

What can be used as adjunct to DMARD for RA

NSAIDS, short term corticosteroids, topical analgesics, physical/occupational therapy, mobility exercises, weight loss

30

ACR/EULAR criteria for dx of RA

- joint involvement
- positive serology (CCP/RF elevated)
- positive acute phase reactants (elevated CRP and ESR)
- duration of symptoms > 6 weeks