Flashcards in Rheum I Deck (48)
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1
What medication is a risk factor for gout?
Thiazide/loop diuretic
2
What is Primary Gout linked to?
Genetic alterations in how the kidney handles urate
3
What is Secondary gout related to?
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
4
Define Chronic gout
Tophaceous Gout:
1. 10+ years
2. Tophi Deposits=Diagnostic
5
What is diagnostic in gout?
Monosodium Urate Crystals
=Needle-like/rod-shaped and negatively birefringent crystals
6
X-ray findings in ESTABLISHED gout
Small, punched-out erosions with overhanging edges=“rat-bite”
*New onset acute gout=No radiographic findings
7
What is first line treatment in gout?
NSAID's: Indomethacin, Naproxen
8
appropriate time frame in the use of Colchicine to use?
24-36 hrs
9
Prophylaxis Gout Treatment
1. Colchicine: Anti-inflammatory
2. Allopurinol: Xanthine Oxidase Inhibitors
3. Probenecid: Uricosuric agents
10
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!
11
Gout complications
1. Nephrolithiasis
2. Chronic urate nephropathy
12
What is the other name for Pseduogout?
calcium pyrophosphate dihydrate disease (CPPD)
13
What joints does pseduogout affect?
Peripheral Joints:
1. KNEE*
2. Wrist
3. Elbow
14
What population does pseduogout MCly affect?
60+
15
X-ray findings in pseudogout
Chondrocalcinosis: Fine, linear densities in articular tissues
16
Joint aspiration findings in pseudogout?
Calcium pyrophosphate crystals: Rhomboid-shaped crystals that are POSITIVELY birefringent w/ light microscopy
17
Pseudogout treatment
1. NSAIDs – acute attacks
2. Colchicine – prophylaxis
3. Intra-articular corticosteroid injection
18
What sex is OA MC in <50 years?
Males
19
What sex is OA MC in >50 years?
Females
20
Who does RA MCly occur in?
Females
21
What is very important in the treatment of RA?
Early aggressive treatment
22
What joints does RA more commonly effect?
SMALL joints
Symmetric
23
What is the most specific blood test for RA? What is the other blood test you will order?
Anti-CCP = Most specific
RF
24
What is 1st line Tx in RA?
DMARDs:
1. Methotrexate
2. Sulfasalazine
3. Leflunomide
4. Hydroxychloroquine
25
What are add on therapies you can consider in RA in combination with DMARDs?
1. NSAIDs
2. Corticosteroids: Low dose Prednisone, Intra-articular
26
How long does it take for Methotrexate to take effect?
2-6 weeks
27
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
28
Sulfasalazine SE's
1. Neutropenia
2. Thrombocytopenia
3. Hemolysis in pt's w/ G6PD deficiency
29
Leflunomide SE's
1. GI upset
2. Rash
3. Alopecia
4. Hepatotoxicity
5. Weight loss
6. Carcinogenic
7. Teratogenic
30
What is important annual maintenance in patient's taking antimalarials (Hydroxychloroquine)? Why?
Eye exams years d/t pigmentary retinitis SE
31
What must you screen a patient for before initiating Biologic treatment in RA?
Laten TB
32
Who must you use extreme caution in with Biologic treatment in RA?
HF
33
RA is associated with what mortality?
CV disease
34
Systemic Juvenile Idiopathic Arthritis (sJIA) diagnostic criteria
1. Fever > 2 wks
2. Arthritis >6 wks
3. Onset before 16
35
What joints do seronegative spondyloarthropathies MCly effect?
Asymmetric arthritis of large peripheral joints
36
What gene is seronegative spondyloarthropathies associated with?
HLA-B27 gene
37
Who does ankylosing spondylitis MCly effect?
Male teens/20's
38
ankylosing spondylitis clinical presentation
1. Worse with REST (in the mornings)
2. BETTER with activity
3. Progressive stiffening of the spine
39
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*
40
What is classic radiographic findings in ankylosing spondylitis?
"Bamboo Spine": Vertebral bodies fused together
41
What is first line treatment inankylosing spondylitis?
NSAIDs
42
Psoriatic Arthritis clinical presentation
1. Mono or Poly Arthritis
2. Asymmetric
3. Nail pitting, oncholysis
4. Swelling of digits
43
What is the classic Radiographic finding in Psoriatic Arthritis?
Pencil Deformity d/t erosion and destruction of bone
44
Psoriatic Arthritis Treatment
1. NSAIDs
2. Methotrexate
3. PDE-4 Inhibitor: apremilas
4. Biologics: TNF inhibitor, Monoclonal ABs
45
What is reactive arthritis precipitated by?
GI or GU infection:
1. Salmonella
2. Shigella
3. Campylobacter
4. E. Coli
5. C. diff
6. Chlamydia
46
What are 80% of patients with reactive arthritis positive for?
HLA-B27
47
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
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