Rheum I

Question 1

What medication is a risk factor for gout?

Answer 1

Thiazide/loop diuretic

Question 2

What is Primary Gout linked to?

Answer 2

Genetic alterations in how the kidney handles urate

Question 3

What is Secondary gout related to?

Answer 3

Acquired causes of hyperuricemia:

1. Meds: diuretics, low dose ASA, cyclosporine, niacin
2. Myeloproliferative disorders
3. Hypothyroidism
4. Alcohol ingestion – increases urate production AND decreases renal excretion

Question 4

Define Chronic gout

Answer 4

Tophaceous Gout:

1. 10+ years
2. Tophi Deposits=Diagnostic

Question 5

What is diagnostic in gout?

Answer 5

Monosodium Urate Crystals

=Needle-like/rod-shaped and negatively birefringent crystals

Question 6

X-ray findings in ESTABLISHED gout

Answer 6

Small, punched-out erosions with overhanging edges=“rat-bite”

*New onset acute gout=No radiographic findings

Question 7

What is first line treatment in gout?

Answer 7

NSAID’s: Indomethacin, Naproxen

Question 8

appropriate time frame in the use of Colchicine to use?

Answer 8

24-36 hrs

Question 9

Prophylaxis Gout Treatment

Answer 9

1. Colchicine: Anti-inflammatory
2. Allopurinol: Xanthine Oxidase Inhibitors
3. Probenecid: Uricosuric agents

Question 10

Dietary modifications in gout

Answer 10

1. Limit all meats
2. Decrease Fat intake
3. Limit/avoid beer
4. Limit/Avoid high-fructose corn syrup
5. Drink plenty of fluids!

Question 11

Gout complications

Answer 11

1. Nephrolithiasis

2. Chronic urate nephropathy

Question 12

What is the other name for Pseduogout?

Answer 12

calcium pyrophosphate dihydrate disease (CPPD)

Question 13

What joints does pseduogout affect?

Answer 13

Peripheral Joints:

1. KNEE*
2. Wrist
3. Elbow

Question 14

What population does pseduogout MCly affect?

Answer 14

60+

Question 15

X-ray findings in pseudogout

Answer 15

Chondrocalcinosis: Fine, linear densities in articular tissues

Question 16

Joint aspiration findings in pseudogout?

Answer 16

Calcium pyrophosphate crystals: Rhomboid-shaped crystals that are POSITIVELY birefringent w/ light microscopy

Question 17

Pseudogout treatment

Answer 17

1. NSAIDs – acute attacks
2. Colchicine – prophylaxis
3. Intra-articular corticosteroid injection

Question 18

What sex is OA MC in <50 years?

Answer 18

Males

Question 19

What sex is OA MC in >50 years?

Answer 19

Females

Question 20

Who does RA MCly occur in?

Answer 20

Females

Question 21

What is very important in the treatment of RA?

Answer 21

Early aggressive treatment

Question 22

What joints does RA more commonly effect?

Answer 22

SMALL joints

Symmetric

Question 23

What is the most specific blood test for RA? What is the other blood test you will order?

Answer 23

Anti-CCP = Most specific

RF

Question 24

What is 1st line Tx in RA?

Answer 24

DMARDs:

1. Methotrexate
2. Sulfasalazine
3. Leflunomide
4. Hydroxychloroquine

Question 25

What are add on therapies you can consider in RA in combination with DMARDs?

Answer 25

1. NSAIDs | 2. Corticosteroids: Low dose Prednisone, Intra-articular

Question 26

How long does it take for Methotrexate to take effect?

Answer 26

2-6 weeks

Question 27

What are we going to monitor with Methotrexate treatment? Why?

Answer 27

1. CBC (WBC count & Platelets): D/t bone marrow suppression 2. LFT's: D/t hepatotoxicity

Question 28

Sulfasalazine SE's

Answer 28

1. Neutropenia 2. Thrombocytopenia 3. Hemolysis in pt's w/ G6PD deficiency

Question 29

Leflunomide SE's

Answer 29

1. GI upset 2. Rash 3. Alopecia 4. Hepatotoxicity 5. Weight loss 6. Carcinogenic 7. Teratogenic

Question 30

What is important annual maintenance in patient's taking antimalarials (Hydroxychloroquine)? Why?

Answer 30

Eye exams years d/t pigmentary retinitis SE

Question 31

What must you screen a patient for before initiating Biologic treatment in RA?

Answer 31

Laten TB

Question 32

Who must you use extreme caution in with Biologic treatment in RA?

Answer 32

HF

Question 33

RA is associated with what mortality?

Answer 33

CV disease

Question 34

Systemic Juvenile Idiopathic Arthritis (sJIA) diagnostic criteria

Answer 34

1. Fever > 2 wks 2. Arthritis >6 wks 3. Onset before 16

Question 35

What joints do seronegative spondyloarthropathies MCly effect?

Answer 35

Asymmetric arthritis of large peripheral joints

Question 36

What gene is seronegative spondyloarthropathies associated with?

Answer 36

HLA-B27 gene

Question 37

Who does ankylosing spondylitis MCly effect?

Answer 37

Male teens/20's

Question 38

ankylosing spondylitis clinical presentation

Answer 38

1. Worse with REST (in the mornings) 2. BETTER with activity 3. Progressive stiffening of the spine

Question 39

What are other conditions/disorders you will see with ankylosing spondylitis?

Answer 39

1. Arthritis of peripheral joints=50% 2. Achilles tendon swelling 3. Plantar Fasciitis 4. Anterior Uveitis*

Question 40

What is classic radiographic findings in ankylosing spondylitis?

Answer 40

"Bamboo Spine": Vertebral bodies fused together

Question 41

What is first line treatment inankylosing spondylitis?

Answer 41

NSAIDs

Question 42

Psoriatic Arthritis clinical presentation

Answer 42

1. Mono or Poly Arthritis 2. Asymmetric 3. Nail pitting, oncholysis 4. Swelling of digits

Question 43

What is the classic Radiographic finding in Psoriatic Arthritis?

Answer 43

Pencil Deformity d/t erosion and destruction of bone

Question 44

Psoriatic Arthritis Treatment

Answer 44

1. NSAIDs 2. Methotrexate 3. PDE-4 Inhibitor: apremilas 4. Biologics: TNF inhibitor, Monoclonal ABs

Question 45

What is reactive arthritis precipitated by?

Answer 45

GI or GU infection: 1. Salmonella 2. Shigella 3. Campylobacter 4. E. Coli 5. C. diff 6. Chlamydia

Question 46

What are 80% of patients with reactive arthritis positive for?

Answer 46

HLA-B27

Question 47

Reactive Arthritis clinical presentation

Answer 47

1. Asymmetrical oligoarthritis of lower extremity: Knee & ankle 2. Fever, wt. loss 3. Extra-articular manifestations: Uveitis/Conjunctivitis, Urethritis, mucocutaneous lesions

Question 48

Reactive Arthritis treatment

Answer 48

1. NSAIDs | 2. Abx: If STI