Non-Systemic Inflammatory Rheumatic Disorders

Question 1

Condition where monosodium urate (MSU) crystals deposit in soft tissues
or joints (less vascular tissue) (Cartilage, tendons, joints -Smaller joints)

Answer 1

Gout

Question 2

When gout happens in the great toe, it is called

Answer 2

Podagra

Question 3

What is the most common cause of inflammatory arthritis in men >40 years old?

Answer 3

Gout

Question 4

Which joints are primarily affected by gout?

Answer 4

Joints involved – usually the cold joints

MTP, forefoot, ankle, knee, wrist, fingers

Question 5

Primary Gout Categories

Answer 5

Overproducers – 10% (HPRT deficient)

Underexcretors- 90%

Question 6

Secondary Gout Causes

Answer 6

Excess nucleoprotein turnover (Lymphoma, Leukemia)

Increased cell proliferation/death (Psoriasis)

Rare genetic disorder (Lesch-Nyan Syndrome)

Pharmaceuticals (diuretics)

Question 7

Four Phases of Gout

Answer 7

1. Asymptomatic hyperuricemia
2. Acute gouty arthritis
3. Intercritical gout
4. chronic tophaceous gout

Question 8

List some causes of Gout

Answer 8

Hyperuricemia (Patients can also have a high level without gout)

High alcohol consumption (Especially beer)

High high-fructose corn syrup diet

Medications (Diuretics – thiazide and loop diuretics, ASA, niacin)

Question 9

Hyperuricemia level in women

Answer 9

Females >6 mg/dL

Question 10

Hyperuricemia level in men

Answer 10

Male > 7mg/dL

Question 11

Common medications that can precipitate gout

Answer 11

Diuretics – thiazide and loop diuretics

ASA

niacin

Question 12

What are some other conditions/signs to consider gout diagnosis/workup?

Answer 12

Renal lithiasis

Uric acid nephropathy

Urate nephropathy

Question 13

What is the definitive diagnosis of gout?

Answer 13

Synovial joint fluid analysis –> MSU crystals in synovial fluid (needle-like, Negative birefringence)

Question 14

On join fluid analysis you see crystals that are needle-like with negative birefringence, this is a diagnosis of what?

Answer 14

Gout

Question 15

X-ray finding in Gout

Answer 15

Punched out lesions (“rat bit sign”, erosion)

Question 16

If you see a “rat bite sign” on an X-ray, what should you suspect?

Answer 16

Gout

Question 17

Which foods should be decreased/eliminated (Low purine diet) post gout?

Answer 17

Decrease EtOH
organ meats
red meats
sardines
high fructose corn syrup

Question 18

What are the two most common drugs used in acute gout?

Answer 18

NSAIDs (Indocin)
Cochicine

Question 19

What is the DOC for chronic tophaceous gout?

Answer 19

Allopurinol

Question 20

What condition is described below?

Usually commences symptomatically 1-8 weeks after exposure to the drug –
symptom complex can be severe

Classic combination: rash, fever, and major internal organ involvement (most
commonly hepatitis, but also can be nephritis and pneumonitis)

Answer 20

Allopurinol Hypersensitivity Syndrome

Question 21

What is the most common type of patient you can see Allopurinol Hypersensitivity Syndrome?

Answer 21

Southeast Asian ancestry

Question 22

What is the marked risk factor for severe allopurinol cutaneous reaction?

Answer 22

HLA-B*5891

Question 23

What demographic of patients are likely to see HLA-B*5891?

Answer 23

Koreans with CKD, and those of Han Chinese and Thai descent

Question 24

What are the features of DRESS? (Drug Reaction with Eosinophilia and Systemic Symptoms)

Answer 24

Cutaneous rash

Fever

Renal dysfunction

Hepatitis

Leukocytosis

Death

Question 25

What does DRESS stand for?

Answer 25

Drug Reaction with Eosinophilia and Systemic Symptoms

Question 26

What is pseudogout?

Answer 26

Calcium pyrophosphate deposition disease

Question 27

Calcium pyrophosphate deposition disease is also known as?

Answer 27

“pseudogout”

Question 28

CCPD presents like:

Answer 28

Gout Pseudo-RA Pseduo-OA Pseudo-ankylosing spondylitis (disk calcification, decreased spinal mobility) Pseudo-neuropathic arthritis (resorptive disease)

Question 29

Pseudogout commonly presents in which joint(s)?

Answer 29

Most commonly presents in the knee Prefers the larger joints (knee, wrist, etc)

Question 30

What condition is described below? Crystals can deposit in cartilage (chondrocalcinosis), synovial cavity, or synovium (chronic)

Answer 30

Pseudogout

Question 31

What are some associated conditions with pseudogout?

Answer 31

Hyperparathyroidism Hypercalcemia Hypocalciuria Hemochromatosis Hypothyroidism Gout Osteoarthritis (Goes hand in hand with OA – every time see CPPD, the patient also has OA going on) Aging (50% in 80s)

Question 32

What is the definitive diagnosis of pseudogout?

Answer 32

Analysis of synovial fluid: CPPD crystals – blunted, rhomboid/prism (or rod) shaped Weakly positive birefringence Light blue when parallel

Question 33

On join fluid analysis you see crystals that are blunted, rhomboid/prism (or rod) shaped with weakly positive birefringence, this is a diagnosis of what?

Answer 33

Pseudogout

Question 34

An Xray that shows an appearance of punctate and linear densities in articular hyaline or fibrocartilaginous tissue should raise your suspicion for what diagnosis/condition?

Answer 34

Pseudogout

Question 35

How is pseudogout treated?

Answer 35

Joint aspiration Injection with steroids NSAIDs There is no medication to reduce the amount of CPPD crystals in your system