Flashcards in MSK Deck (420)
What is Raynaud's phenomenon?
peripheral digital ischemia due to paroxysmal vasospasm affecting arteries supplying fingers and toes
What precipitates Raynaud's syndrome?
What relieves Raynaud's syndrome?
What are the symptoms of Raynaud's syndrome?
numbness, burning sensation, severe pain when warmed up
Who is mainly affected by Raynaud's syndrome?
What happens in Raynaud's syndrome?
initial pallor from vasoconstriction, followed by cyanosis due to sluggish blood flow, then redness from hyperamia
DD of Raynaud's syndrome?
autoimmune rheumatic disease, bb therapy, raynauds disease
What is the treatment of Raynaud's syndrome?
stop smoking, keep hands and feet warm, oral nefdipine, prostacyclin infusions, lumbar symphathectomy, evening primrose oil, sildenafil, prostsacyclin, vasodilators, avoid vibrating tools
What are the causes of gout?
hereditary, increased dietary purines, alcohol excess, diuretics, leukaemia, cytotoxics
Where do we acquire purines from?
from the break down of food or break down inown tissues in pathway
What are purines broken down into?
hypoxanthine, xanthine and then uric acid to be carried around in the bloodstream
What are the two outcomes for uric acid in humans?
be removed by the kidney or into monosodium urate crystals
What happens if there us a build up on uric acid?
overflows in the kidneys and becomes crystals in the joints and tissues
What can cause a increase of urate?
increased urate in diet, increase in cell death and turnover, increased cell damage, decreased excetion, drugs, fructose, genetics, increase in insulin levels, red meat, seafood
What 4 conditions can hyperuricaemia and deposition of sodium urate crystals result in?
acute gout, chronic polyarticular gout, chronic tophaceous gout, urate renal stone formation
What conditions can gout be a marker for?
CV disease, hypertension, diabetes, chronic renal failure
How common is gout?
prevalence is around 1%
Is gout more common in males or females?
Male, rare before adulthood
How many people with hyperuricaemia develop gout?
What foods help against gout?
dairy, cherries, vit C, carbohydrate, smaller meals, 2000 calories
What is the saturation point of uric acid compared to the normal range?
Normal = 200-430umol/L
Saturation = 380umol/L
What is acute gout?
inflammatory arthritis caused by hyperuricaemia and intra articular sodium urate crystals
What causes acute gout?
A sudden change in blood:tissue urate balance, either sudden overload or sudden reduction (ULT), cold, trauma, sepsis, dehydration, drugs
What symptoms does acute gout cause?
urate crystals trigger intracellular inflammation, causes severe pain, swelling, redness, commonly on metatarsophalangeal joint of big toe
What is the treatment of acute gout?
colchicine 500ug max tds, NSAIDs, steroids, ice, cherries, vit C, coxib
How does chronic trophaceous gout present?
large, smooth, white deposits (tophi) in the skin and around the joints, particularly on ear, fingers and Achilles tendon
What investigations can be used for gout?
polarised light microscopy of joint synovial fluid shows negatively birefringent urate crystal, raised serum urate (but can be normal in acute attack), radiographs show tissue swelling, serum urea and creatinine show renal impairment, well defined punched out erosions in juxta articular bone, no sclerotic reaction, joint spaces preserved till late
What is the long term treatment of gout?
stop diuretics and use losartan or fenofibrate instead, reduce weight, stop smoking, change diet, reduce alcohol, allopurinol 100mg/day, colchicine, NSAIDs, steroids
What should the starting dose for allopurinol be and how much should it be increased by if serum urate is not below 300 - WITH NO RENAL IMPAIRMENT??
100mg/day, increased by 100mg