ACUTE ARTHRITIS Flashcards
often not noticed (rash, flu like), what stage of Lyme disease?
stage 1
cardiac, neurologic symptoms, what stage of Lyme disease?
stage 2
RA, SLE, rocky MSF, other, spirochetes, serologically negative disease is rare?
false positive tests for Lyme disease
confirmed with western blot and travel history
abrupt onset at night
podagra at the 1st MTP
initially monoarticular, then polyarticular
subsides on its own
top and x ray findings rare at outset
intra articular, intracellular crystals
may have hyperurecemia
acute gouty arthritis
how does gout present?
parallel, yellow negative birefringence
intracellular
what is key about confirming gout?
joint fluid
drugs that can increase production or under excrete?
thiazides, nicotinic acid
post surgery clinical situations of hyperurecemia?
dehydration, increase cell turnover
post transplant situation of hyperurecemia?
careful with cyclosporin, diuretics, consider MMF
major tx for gout?
NSAIDs
colchicine
prednisone
joint aspiration and intra articular corticosteroids
tx for chronic gout?
prophylaxis with NSAIDs, colchicine \
overproducers
- allopurinol
- -xanthine oxidase inhibitor
- -careful with allopurinol and azathioprine
- restarting allopurinol can induce acute attack
underproducers
-probenecid, sulfinpyrazone
major uses of allopurinol and toxicities
overproducers tophi unresponsive or intolerant to other therapies nephrolithiasis renal insufficiency age > 60 prophylaxis for chemo -toxicity: rash, including SJS, GI distress, hepatitis, gout
gout crystals?
yellow parallel, blue perpendicular
intracellular, needle shaped, negative birefringence
pseudo gout crystal description parallel and perpendicular?
blue and yellow
tx for pseudo gout?
joint aspiration
nsaids
colchicine
screen patients for underlying diseases
