3. Hot Swollen Joints

Question 1

Ix for septic athritis

Answer 1

Aspirate and perform gram stain and blood cultures prior to Abx
- 2 cultures, 48hrs

Question 2

What Abx given for septic arthritis

Answer 2

Fluclox, as staph or strep more common

Question 3

Is crystal arthritis painful or painless

Answer 3

Painful

Question 4

What joint is most commonly affected in first presentation of gour

Answer 4

1st MTP

Question 5

What causes joint destruction in gout

Answer 5

Tophaceous deposits

Question 6

Is gout more common in males or females

Answer 6

Males

Question 7

What are the criteria for scoring gout

Answer 7

Male sex
prev arthritis attacj
rapid onset ( within 1 day)
Joint redness
MTP1 involvement
Hypertension or 1 or more CVS
Serum uric acid high
Score more than 8 gives 80% likelihood of gout

Question 8

Role of urate in acute gout

Answer 8

unreliable, acts as negative APR, goes down as CRP increases

Question 9

What drugs cause hyperuricaemia

Answer 9

Furosemide, bendrolumathiazide

Question 10

what is urate lowering therapy

Answer 10

Allopurinol or febuxostat

Question 11

How does ULT affect disease

Answer 11

Pardoxical flares but helps to reduce recurrence

Question 12

What prophylaxis can be given for paradoxical flares

Answer 12

Colchicine

Question 13

Urate target in newly Dx and tophi

Answer 13

<0.3mmol/L

Question 14

What does carti;age calcifigation with rhomboidal positively birefringent crystals on aspirate suggest

Answer 14

Pseudogout

Question 15

What is the background disease for idiopathic pseudogout

Answer 15

OA

Question 16

What are causes of acquired pseudogout

Answer 16

Primary hyperparathuroidism., haemochromatosis and Wilson’s

Question 17

What are the common opportunistic infections in anti TNF a pts

Answer 17

V zoster, pneumocystis jiroveci

Question 18

Which joint is most commonly involved in pseudogout

Answer 18

Knee

Question 19

How id Dx of gout made

Answer 19

Acute swelling and erythema of 1st MPJ in middle aged male is highly suggestive of gout

But definitive Dx requires identification of urate crystals in synovial fluid or from tophi

Question 20

When should serum urate be measured:
To test ULT
After acute presentation

Answer 20

After 2 weeks of ULT
4-6 weeks after presentation

Question 21

Side effects of colchine

Answer 21

GI effects- diarrheoa, colic

Question 22

Contra for colchicine

Answer 22

Renal or hepatic impairment pts taking P-glycoprotein or strong CYP3A4 inhib

Question 23

Allopurinol drug interaction

Answer 23

Reduce aza dose if with allopurinol.

Question 24

Should Allopurinol or febuxostat be used in severe renal and hepatic impairment

Answer 24

Allo

Question 25

Risk factors for gout

Answer 25

male sex, obesity, CVD, RVD, old age, alcohol, fructose consumption and purine intake

Question 26

First line treatment for gout patients (acutely)

Answer 26

Full strength non-steroidal eg. naproxen