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Foundations 3 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is gout?

How is it caused?

Who is it most common in?

A

An Altered purine metabolism that results in sodium urate crystal deposition in synovial fluid

Abnormal deposits of urate cause recurring, acute arthritis attacks

MC in Men >30

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2
Q

Which medications put a patient at an increased risk for Gout?

A

Thiazide/loop diuretics

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3
Q

What can cause Secondary Gout?

A

Meds: diuretics, low dose ASA, cyclosporine, niacin
Myeloproliferative disorders
Hypothyroidism
Alcohol ingestion –> increase urate

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4
Q

How is Primary gout classified?

A

linked to genetic alterations in how the kidney handles urate

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5
Q

How does acute Gout present

A

Acute intense pain AT NIGHT

Swollen, tender joint with overlying skin that is red and warm

Often involves first MTP joint (called podagra)

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6
Q

Is gout considered polyarticular or monoarticular?

A

Monoarticular (only affects one joint)

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7
Q

How long must you have Gout in order to be considered chronic?

A

10 years

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8
Q

What occurs in patients with chronic Gout?

A

Urate deposits in subcutaneous tissue, bone, cartilage, joints

Surrounded by granulomatous inflammation

Deposits are called tophi and are diagnostic

Create a deforming polyarthritis

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9
Q

What labs can be used to diagnose Gout?

Which is most definitive

A

Serum uric acid
WBC
Synovial fluid analysis**

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10
Q

In a synovial fluid analysis what findings will indicate Gout under polarizing light microscopy?

A

monosodium urate crystals are diagnostic

needle like crystals

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11
Q

What are radiographic findings with Gout?

A

small, punched-out erosions with overhanging edges (“rat-bite”)

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12
Q

Treatment for Gout

Which is 1st line

A
  1. Elevation, rest
  2. Diet modifications- decreases purines and alcohol to lower urate
  3. NSAIDS***
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13
Q

Which NSAIDS are used for GOUT

A

Indomethacin (classically used)
Naproxen
Colchicine - if attack is less than 24-36 hours old

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14
Q

What meds should be avoided with Gout?

A

Avoid thiazide and loop diuretics – inhibit renal excretion of uric acid

Niacin – raises serum uric acid levels

Low dose aspirin +/-

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15
Q

What prophylactic medications can be used for Gout

A

Colchicine
Xanthin Oxidase inhibitors
Uricosuric agents

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16
Q

Treatment for Pseudogout?

A

NSAIDs – acute attacks
Colchicine – prophylaxis
Intra-articular corticosteroid injection

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17
Q

What is Pseudogout and what is deposited?

Who is this most common in?

A

Affects peripheral joints
Deposits of calcium pyrophosphate

MC in elders 60+

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18
Q

What imagine tool is used to assess Pseudogout?

What findings are diagnostic?

A

X-ray

Calcium pyrophasphate crystals
Rhomboid shaped crystals that are positively birefringement

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19
Q

What is the ideal way to diagnose Pseudogout?

A

Joint Aspiration

Id of calcium pyrophosphate crystals is diagnostic: rhomboid-shaped crystals that are positively birefringent with light microscopy

“think P” = Pyrophosphate and Positve

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20
Q

Where is the MC area that Pseudogout affects?

A

Knee
Wrist
Elbow

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21
Q

What is the MC joint disease?

Which age group is most affected?

A

Osteoarthritis

Older >65

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22
Q

Clinical presentation of Osteoarthritis?

A

Joint pain

  • Insidious onset
  • Worsens with activity, relieved with rest
  • Brief morning stiffness (< 30 minutes)

Crepitus (grinding noise)
Loss of ROM

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23
Q

Different between Heberden nodes and Bouchard nodes

A

Heberden nodes – bony enlargements of DIPs

Bouchard nodes – bony enlargements of PIPs

24
Q

What are X-ray findings you will see with Osteoarthritis?

A

Asymmetric narrowing of joint space
Osteophytes
Thickened subchondral bone
Bony cysts

25
Q

What Labs would you grab for Osteoarthritis?

A

synovial fluid

26
Q

What are 1st line pharmacologic treatments for Osteoarthritis

A
  1. Acetaminophen or NSAIDS***
27
Q

If initial treatment for Osteoarthritis does not work what kind of injections are available?

A

Corticosteroid injections - 4x per year

Sodium Hyaluronate

28
Q

What are surgical options for Osteoarthritis?

A

Arthroscopy

Joint replacement

29
Q

What is Rheumatoid Arthritis?

A

Chronic, progressive, systemic inflammatory disease

Synovitis of multiple joints

30
Q

What is the clinical presentation of Rheumatoid Arthritis

A

Morning stiffness (>30 minutes)

Insidious onset

Symmetric swelling of multiple joints with tenderness and pain

Symmetric polyarthritis of small joints of hands and feet

31
Q

What is the cause of Rheumatoid arthritis?

A

Unknown

Genetic susceptibility due to multiple genes

32
Q

What Labs can be used to diagnose Rheumatoid arthrititis?

Which lab is most specific to diagnose with?

A

RF + anti-CCP

anti-CCP is most specific

33
Q

What is the diagnostic criteria for Rheumatoid arthritis?

A

Number and type of joints involved
Serology (RF and anti-CCP [also called ACPA]
Acute phase reactants (CRP and ESR)
Symptom duration of at least 6 weeks

34
Q

Treatment for Rheumatoid arthritis?

A

Start DMARDS therapy as soon as diagnosis is certain

Methotrexate
Sulfasalazine (Azulfidine)
Leflunomide (Arava)
Hydroxychloroquine (Plaquenil)

***Use NSAIDS in conjunction for pain relief

35
Q

Which medication is the initial DMARD choice for RA?

What are side effects?

A

Methotrexate

GI upset, stomatitis
Decrease in WBCs and platelets due to bone marrow suppression***
Hepatotoxicity with cumulative dose
Teratogenic

36
Q

What are adverse effects of taking 2nd line Sulfasalazine?

A

Neutropenia, thrombocytopenia

37
Q

What are adverse effects of Hydroxychloroquine?

What must be done when taking this?

A

pigmentary retinitis in 2%

Eye exams are required yearly

38
Q

What are risks associated when taking biologic DMARDS?

What precautions must be done before starting?

A

Increased risk for infection and malignancy

Must screen for latent TB before initiating

39
Q

What is Systemic Juvenile Idiopathic Arthritis (sJIA)

A

Arthritis occurring in teens less than 16 years old

40
Q

Presentation of sJIA?

A 
Fever
Arthritis (mono-, oligo-, or poly-arthritis)
Rash
Lymphadenopathy
ANA &amp; Rf rarely seen
41
Q

Diagnostic criteria for sJIA?

A

intermittent, daily fevers and arthritis
Fever ≥ 2 weeks
Arthritis ≥ 6 weeks
Onset before 16 years

42
Q

Treatment for sJIA?

A

Pediatric rheumatologist
Physical therapy
Occupational therapy
Registered dietician

43
Q

What is Seronegative Spondyloarthropathies

What gene is associated with this?

A

Inflammatory arthritis of spine and sacroiliac joints

Asymmetric arthritis of large peripheral joints

HLA-B27 gene

44
Q

What is Ankylosing Spondylitis?

A

Chronic inflammatory disease of joints of axial skeleton
Onset usually in teens or late 20’s
Male > female

45
Q

Clinical Presentation of Ankylosing Spondylitis?

A 
Gradual, intermittent back pain
 - Worse in morning
 - Radiation to buttocks
 - Improves with activity
Progressive stiffening of the spine
Anterior uveitis (25%)
Arthritis of peripheral joints (50%)
46
Q

Diagnostic labs for Ankylosing Spondylitis?

A

Elevation of ESR (in 85%)
Negative RF and anti-CCP antibodies
CBC – mild anemia
HLA B27 + in 92% of white patients and 50% of black patients with AS

47
Q

What are findings you expect to see on imaging with Ankylosing Spondylitis

A

Earliest evidence is in SI joints – erosion, sclerosis
Bilateral, symmetric

Bamboo spine – appearance of spinal column when the vertebral bodies fuse together

48
Q

Treatment for Ankylosing Spondylitis?

A

NSAIDs first line
TNF inhibitors
Corticosteroids – minimal impact, can cause osteopenia
Sulfasalazine (peripheral arthritis)

49
Q

What is the cause of Psoriatic Arthritis

A

Skin psoriasis usually precedes arthritis

50
Q

Clinical presentation of Psoriatic Arthritis?

A 
Many forms – monoarthritis, polyarthritis
Nail pitting, onycholysis
Usually asymmetric
SI joint involvement common
Sausage swelling of digits
51
Q

What labs can be used to diagnose Psoriatic arthritis?

A

Labs
Elevated ESR
RF negative

52
Q

What image findings do you see in Psoriatic arthritis

A

Erosion and destruction of bone
Osteolysis
Pencil deformity
Asymmetric sacroilitis

53
Q

Treatment for Psoriatic arthritis

A

NSAIDs
Methotrexate – for those who do not respond to NSAIDs
Can improve joint and skin symptoms
Phosphodiesterase-4 inhibitor

54
Q

What is Reactive arthritis?
Who is it common in?
What is it precipitated from?

A

Asymmetrical oligoarthritis of lower extremity
Mostly knee and ankle
MC in young men
Precipitated by GI and GU infection

55
Q

What are extra-articular manifestations that can happen with Reactive arthritis? (Think triad)

A

Urethritis
Conjunctivitis
Uveitis

56
Q

What are mucocutaneous lesions that can happen from Reactive arthritis?

A

Balanitis
Stomatitis (mouth ulcers, painless)
Keratoderma blennorrhagicum

57
Q

Treatment for Reiters arthritis?

A

NSAIDs

Antibiotics given for STI reduces chance of reactive arthritis occurring

Foundations 3 (25 decks)

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