rheum III and IV Flashcards
(94 cards)
gout
- deposition of uric acid crystals in joints, tissues, fluids
- hyperuricemia does NOT equal gout
- common with other comorbidities
- extremely painful
tophi
- uric acid crystals in tissue
what is the cause of 90% of gout cases?
- under excretion
- mostly associated with renal disorders
over production of uric acid is mainly associated with what?
- excessive dietary purines like red meat, organ meat, shellfish
- beer
risk factors for gout
- male
- advanced age
- AA or pacific islander
- alcohol and high purine intake
- obesity, HTN, hyperlipidemia, diabetes
- diuretics (HCTZ)
- lead exposure
- women after menopause
- genetics
clinical presentation of gout
- podagra
- very tender
- acute onset
- redness
- 50% first attack in MTP of great toe
- predilection for feet, ankles, toes
- renal sx- uric acid stones and gouty nephropathy
PE findings with acute gout
- usually monoarticular and TTP
- skin is warm, tense, red
PE findings with chronic gout
- tophi deposition
- CT destruction and gross deformities
- infection
- drainage
- bone destruction and erosion -> functional loss
differential dx for gout
- cellulitis
- bug bite
- septic joint
- RA
- pseudogout
diagnosis of gout
- arthrocentesis shows intracellular UA crystals*
- negative birefringence under microscopy*
- check gram stain
- elevated UA > 6.8 (not diagnostic)
- get 24 hour urine
- xrays
xray findings in gout
- early on only soft tissue swelling
- late shows bony erosions with sclerotic margins, calcification
acute gout treatment
- diet modifications
- NSAIDs first line (indomethacin) within 24 hrs
- 2nd line- colchicine
- 3rd line- steroids
- antihyperuricemic tx for prevention and reversal of consequences
- treat comorbidities
chronic gout treatment
- lower urate level to < 5
- 2-4 weeks after acute attack f/u and check urate levels
- allopurinol first line
- probenecid is first line if allopurinol is c/i
- colchicine for flares
- NSAIDs
- cherries decrease gout risk
- combo drugs if levels not achieved
indications for chronic gout treatment
- multiple attacks
- tophaceous deposits
- gout with renal insufficiency
- nephrolithiasis even after tx
- uric acid levels of 6.5 +
pseudogout
- chondrocalcinosis
- Ca pyrophosphate dihydrate (CPPD) deposition
- mainly affects knees
- can be asymptomatic or mimic other diseases
- often occurs following anesthesia/ surgery
risk factors for pseduogout
- hypercalcemia
- metabolic conditions
clinical presentation of pseudogout
- may be asymptomatic
- monoarticular
- often in knee
- can affect wrists, MCP, hips, shoulders, elbows, ankles
- red, warm, tender, swollen
- valgus deformity
- often resolves on its own
- fever possible
- ligamentum flavum in spine involved
diagnosis of pseudogout
- CPPD deposition in kidneys and joints
- CPPD stone
- positive birefringence rhomboid crystals*
- elevated ESR and CRP
- chondrocalcinosis on xrays**
- test for serum Ca, P, Mg, Alk phos, TSH
differential dx of pseudogout
- gout
- septic arthritis
- RA if polyarticular
- primary or post-traumatic OA
acute treatment of pseudogout
- NSAIDs
- colchicine short term
- steroids short term
- drain fluid
- rest/ice
chronic treatment of pseudogout
- > 3 attacks per year
- 1st line- colchicine
- 2nd line- NSAIDs
Fibromyalgia
- chronic pain disorder wit widespread pain and allodynia
- central sensitization
- usually women 20-50
- increased incidence of depression, anxiety, HA, IBS, chronic fatigue syndrome, SLE, RA
allodynia
- pain d/t stimulus that does not normally provoke pain
clinical manifestations of fibromyalgia
- widespread pain
- abnormal tenderness, fatigue, sleep disturbances, autonomic disturbances
- GI or GU sx
- chronic HA, poor concentration, memory disorder
- stiffness
- sensation of swelling without evidence of swelling**
- widespread multiple tender points**
- paresthesias