Painful joints (week 6) Flashcards
(29 cards)
what is gout caused by
deposition of monosodium urate monohydrate crystals in/around synovial joints
what are the risk factors for gout
alcohol use
high fructose sweetened drinks
high meat and seafood consumption
heart disease, hypertension, diabetes, hyperlipidaemia
renal disease
drugs
name for elevated uric acid levels in the blood
hyperuricemia
what creates the danger signal for the inflammatory response in gout
uric acid crystals
which sex is gout more prevalent in
males (L)
what is the main abnormality which causes gout
reduced uric acid excretion by the kidney (genetically determined)
typical features of gout
rapid onset (max severity in 2-6 hrs)
severe pain
extreme tenderness - can’t stand anything touching it
swelling with red shiny skin
goes away after 5-14 days
what is the inflammation of a joint called
synovitis
second attacks? (gout)
often occur within a year and may progress to chronic gout
features of chronic gout
chronic pain, joint damage, occasionally severe deformity and functional impairment
what do crystals deposited in joints and soft tissues form (gout)
tophi - irregular firm nodules
what differentiates nodules in gout to nodules in rheumatoid arthritis
tophi are white
gout investigations
identifying urate crystals in aspirate from joint
biochemical screen - hyperuricaemia usually present in gout
X-rays
treatment for acute gout
NSAIDs
cause of septic arthritis
bacteria in joint
what is the most important risk factor for septic arthritis
increasing age
risk factors for septic arthritis
age, re-existing joint disease (RA), diabetes, immunosuppression, intravenous drug misuse
clinical features of septic arthritis
swollen hot red joint with pain resting and moving. mainly lower limbs.
management of septic arthritis
antibiotics - flucloxacillin
differences in morning stiffness between OA and RA
OA around 15 mins, RA normally longer
identifying sepsis
high/low temperature
tachycardia - high heart rate
tachypnoea - high breathing rate
low blood pressure
hypoxia - low levels of oxygen in tissues
reduced urine output
cold hand and feet
confusion/drowsiness
first step when looking at an inflamed joint
aspirate joint (bacteria? crystals?) and send blood cultures
what reduces uric acid production and how
allopurinol - inhibits xanthine oxidase
what’s the danger signal for RA
altered self-protein - protein isn’t identified as ‘self’
