Flashcards in Rheum I Deck (48)
What medication is a risk factor for gout?
What is Primary Gout linked to?
Genetic alterations in how the kidney handles urate
What is Secondary gout related to?
Acquired causes of hyperuricemia:
1. Meds: diuretics, low dose ASA, cyclosporine, niacin
2. Myeloproliferative disorders
4. Alcohol ingestion – increases urate production AND decreases renal excretion
Define Chronic gout
1. 10+ years
2. Tophi Deposits=Diagnostic
What is diagnostic in gout?
Monosodium Urate Crystals
=Needle-like/rod-shaped and negatively birefringent crystals
X-ray findings in ESTABLISHED gout
Small, punched-out erosions with overhanging edges=“rat-bite”
*New onset acute gout=No radiographic findings
What is first line treatment in gout?
NSAID's: Indomethacin, Naproxen
appropriate time frame in the use of Colchicine to use?
Prophylaxis Gout Treatment
1. Colchicine: Anti-inflammatory
2. Allopurinol: Xanthine Oxidase Inhibitors
3. Probenecid: Uricosuric agents
Dietary modifications in gout
1. Limit all meats
2. Decrease Fat intake
3. Limit/avoid beer
4. Limit/Avoid high-fructose corn syrup
5. Drink plenty of fluids!
2. Chronic urate nephropathy
What is the other name for Pseduogout?
calcium pyrophosphate dihydrate disease (CPPD)
What joints does pseduogout affect?
What population does pseduogout MCly affect?
X-ray findings in pseudogout
Chondrocalcinosis: Fine, linear densities in articular tissues
Joint aspiration findings in pseudogout?
Calcium pyrophosphate crystals: Rhomboid-shaped crystals that are POSITIVELY birefringent w/ light microscopy
1. NSAIDs – acute attacks
2. Colchicine – prophylaxis
3. Intra-articular corticosteroid injection
What sex is OA MC in <50 years?
What sex is OA MC in >50 years?
Who does RA MCly occur in?
What is very important in the treatment of RA?
Early aggressive treatment
What joints does RA more commonly effect?
What is the most specific blood test for RA? What is the other blood test you will order?
Anti-CCP = Most specific
What is 1st line Tx in RA?
What are add on therapies you can consider in RA in combination with DMARDs?
2. Corticosteroids: Low dose Prednisone, Intra-articular
How long does it take for Methotrexate to take effect?
What are we going to monitor with Methotrexate treatment? Why?
1. CBC (WBC count & Platelets): D/t bone marrow suppression
2. LFT's: D/t hepatotoxicity
3. Hemolysis in pt's w/ G6PD deficiency
1. GI upset
5. Weight loss
What is important annual maintenance in patient's taking antimalarials (Hydroxychloroquine)? Why?
Eye exams years d/t pigmentary retinitis SE
What must you screen a patient for before initiating Biologic treatment in RA?
Who must you use extreme caution in with Biologic treatment in RA?
RA is associated with what mortality?
Systemic Juvenile Idiopathic Arthritis (sJIA) diagnostic criteria
1. Fever > 2 wks
2. Arthritis >6 wks
3. Onset before 16
What joints do seronegative spondyloarthropathies MCly effect?
Asymmetric arthritis of large peripheral joints
What gene is seronegative spondyloarthropathies associated with?
Who does ankylosing spondylitis MCly effect?
ankylosing spondylitis clinical presentation
1. Worse with REST (in the mornings)
2. BETTER with activity
3. Progressive stiffening of the spine
What are other conditions/disorders you will see with ankylosing spondylitis?
1. Arthritis of peripheral joints=50%
2. Achilles tendon swelling
3. Plantar Fasciitis
4. Anterior Uveitis*
What is classic radiographic findings in ankylosing spondylitis?
"Bamboo Spine": Vertebral bodies fused together
What is first line treatment inankylosing spondylitis?
Psoriatic Arthritis clinical presentation
1. Mono or Poly Arthritis
3. Nail pitting, oncholysis
4. Swelling of digits
What is the classic Radiographic finding in Psoriatic Arthritis?
Pencil Deformity d/t erosion and destruction of bone
Psoriatic Arthritis Treatment
3. PDE-4 Inhibitor: apremilas
4. Biologics: TNF inhibitor, Monoclonal ABs
What is reactive arthritis precipitated by?
GI or GU infection:
4. E. Coli
5. C. diff
What are 80% of patients with reactive arthritis positive for?
Reactive Arthritis clinical presentation
1. Asymmetrical oligoarthritis of lower extremity: Knee & ankle
2. Fever, wt. loss
3. Extra-articular manifestations: Uveitis/Conjunctivitis, Urethritis, mucocutaneous lesions