Rheum I Flashcards Preview

Foundations-MSK > Rheum I > Flashcards

Flashcards in Rheum I Deck (48)
Loading flashcards...
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

48

Reactive Arthritis treatment

1. NSAIDs
2. Abx: If STI