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Foundations 3 > Rheumatology > Flashcards

Rheumatology Flashcards

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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

Study These Flashcards
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?

Study These Flashcards
A

Asymmetric narrowing of joint space
Osteophytes
Thickened subchondral bone
Bony cysts

25
What Labs would you grab for Osteoarthritis?
synovial fluid
26
What are 1st line pharmacologic treatments for Osteoarthritis
1. Acetaminophen or NSAIDS***
27
If initial treatment for Osteoarthritis does not work what kind of injections are available?
Corticosteroid injections - 4x per year | Sodium Hyaluronate
28
What are surgical options for Osteoarthritis?
Arthroscopy | Joint replacement
29
What is Rheumatoid Arthritis?
Chronic, progressive, systemic inflammatory disease | Synovitis of multiple joints
30
What is the clinical presentation of Rheumatoid Arthritis
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
What is the cause of Rheumatoid arthritis?
Unknown | Genetic susceptibility due to multiple genes
32
What Labs can be used to diagnose Rheumatoid arthrititis? Which lab is most specific to diagnose with?
RF + anti-CCP anti-CCP is most specific
33
What is the diagnostic criteria for Rheumatoid arthritis?
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
Treatment for Rheumatoid arthritis?
Start DMARDS therapy as soon as diagnosis is certain Methotrexate Sulfasalazine (Azulfidine) Leflunomide (Arava) Hydroxychloroquine (Plaquenil) ***Use NSAIDS in conjunction for pain relief
35
Which medication is the initial DMARD choice for RA? What are side effects?
Methotrexate GI upset, stomatitis Decrease in WBCs and platelets due to bone marrow suppression*** Hepatotoxicity with cumulative dose Teratogenic
36
What are adverse effects of taking 2nd line Sulfasalazine?
Neutropenia, thrombocytopenia
37
What are adverse effects of Hydroxychloroquine? What must be done when taking this?
pigmentary retinitis in 2% | Eye exams are required yearly
38
What are risks associated when taking biologic DMARDS? What precautions must be done before starting?
Increased risk for infection and malignancy Must screen for latent TB before initiating
39
What is Systemic Juvenile Idiopathic Arthritis (sJIA)
Arthritis occurring in teens less than 16 years old
40
Presentation of sJIA?
``` Fever Arthritis (mono-, oligo-, or poly-arthritis) Rash Lymphadenopathy ANA & Rf rarely seen ```
41
Diagnostic criteria for sJIA?
intermittent, daily fevers and arthritis Fever ≥ 2 weeks Arthritis ≥ 6 weeks Onset before 16 years
42
Treatment for sJIA?
Pediatric rheumatologist Physical therapy Occupational therapy Registered dietician
43
What is Seronegative Spondyloarthropathies What gene is associated with this?
Inflammatory arthritis of spine and sacroiliac joints Asymmetric arthritis of large peripheral joints HLA-B27 gene
44
What is Ankylosing Spondylitis?
Chronic inflammatory disease of joints of axial skeleton Onset usually in teens or late 20’s Male > female
45
Clinical Presentation of Ankylosing Spondylitis?
``` 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
Diagnostic labs for Ankylosing Spondylitis?
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
What are findings you expect to see on imaging with Ankylosing Spondylitis
Earliest evidence is in SI joints – erosion, sclerosis Bilateral, symmetric Bamboo spine – appearance of spinal column when the vertebral bodies fuse together
48
Treatment for Ankylosing Spondylitis?
NSAIDs first line TNF inhibitors Corticosteroids – minimal impact, can cause osteopenia Sulfasalazine (peripheral arthritis)
49
What is the cause of Psoriatic Arthritis
Skin psoriasis usually precedes arthritis
50
Clinical presentation of Psoriatic Arthritis?
``` Many forms – monoarthritis, polyarthritis Nail pitting, onycholysis Usually asymmetric SI joint involvement common Sausage swelling of digits ```
51
What labs can be used to diagnose Psoriatic arthritis?
Labs Elevated ESR RF negative
52
What image findings do you see in Psoriatic arthritis
Erosion and destruction of bone Osteolysis Pencil deformity Asymmetric sacroilitis
53
Treatment for Psoriatic arthritis
NSAIDs Methotrexate – for those who do not respond to NSAIDs Can improve joint and skin symptoms Phosphodiesterase-4 inhibitor
54
What is Reactive arthritis? Who is it common in? What is it precipitated from?
Asymmetrical oligoarthritis of lower extremity Mostly knee and ankle MC in young men Precipitated by GI and GU infection
55
What are extra-articular manifestations that can happen with Reactive arthritis? (Think triad)
Urethritis Conjunctivitis Uveitis
56
What are mucocutaneous lesions that can happen from Reactive arthritis?
Balanitis Stomatitis (mouth ulcers, painless) Keratoderma blennorrhagicum
57
Treatment for Reiters arthritis?
NSAIDs | Antibiotics given for STI reduces chance of reactive arthritis occurring

Foundations 3 (25 decks)

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