Arthritis 2 Flashcards
diagnosis of crystalline arthritis can only be made with what?
microscopic examination of synovial fluid
How many WBC would you expect to see in microscopy examination of gout?
5,000+
Gout results from deposition of what type of crystals?
monosodium urate crystals
What is an example of gouty nephropathy?
uric acid kidney stones
Gout is most common in what population?
adult men (5th decade)
What are the 3 stages of gout?
- asymptomatic hyperuricemia
- acute intermittent gout (acute gouty arthritis with painless asymptomatic periods)
- chronic tophaceous gout (chronic joint pain + destruction “tophi”)
Acute gouty arthritis usually involves what joint?
first metatarsophalangeal joint
What are the 3 protective modalities for acute gouty arthritis?
- medications (CCBs and ARBs)
- foods (cherries, milk, coffee)
- exercise/weight loss
How is the diagnosis of acute gouty arthritis made?
a. plain films
b. uric acid crystals
c. monosodium urate crystals
d. calcium crystals
e. serum uric acid levels
c. monosodium urate crystals
* under polarized microscopy*
Negatively birefringent bright needle-shaped yellow crystals is diagnostic for which of the following?
a. gout
b. pseudogout
a. gout
Which of the following is the best medication to initiate in an acute gouty arthritis attack?
a. allopurinol
b. losartan
c. colchicine
d. acetaminophen
e. indomethacin
c. colchicine
indomethacin is second choice
never give allopurinol for acute attacks
*
What is the main side effect with colchicine?
diarrhea
Which of the following is NOT a good treatment option for an acute gouty arthritis attack?
a. allopurinol
b. prednisone
c. colchicine
d. indomethacin
e. no medication
allopurinol
although colchicine is first like if the patient prefers a treatment option give them what they want
Which of the following is the best urate-lowering medication?
a. allopurinol
b. losartan
c. colchicine
d. acetaminophen
e. indomethacin
a. allopurinol
If a patient has a contraindication to Allopurinol what is the second line treatment for lowering uric acid?
- Febuxostat
What are the 2 main side effects of Allopurinol?
- hypersensitivity (rash)
- difficult to use with reduced GFR
What are the 2 drugs known to be uricosurics, a class of drug that increases renal excretion of urate?
- Probenecid
- ARBs
Probenecid was made famous due to what?
olympic athletes used it to mask steroid use
Why is allopurinol contraindicated in an acute gout attack?
rapid reduction of urate levels can precipitate an acute attack
DO NOT give allopurinol alone, or during an acute attack
Where does pseudogout most likely occur?
a. shoulder
b. elbow
c. hip
d. knee
e. hands
d. knee
What is the cause of pseudogout?
precipitation of calcium pyrophosphate dihydrate (CPPD) crystals in articular cartilage
If a young patient presents with pseudogout what 2 things should be on your differential?
- hereditary hemochromatosis
- hyperparathyroidism
positively-birefringent blue rhomboid-shaped crystals are consistent with which of the following?
a. gout
b. pseudogout
b. pseudogout
What is the treatment for pseudogout?
same as for gout, except no role for urate-lowering therapy (allopurinol)
Which of the following is a true medical emergency?
a. rheumatoid arthritis flare up
b. gout
c. pseudogout
d. septic arthritis
d. septic arthritis
What is the best physical exam finding for septic arthritis?
- micromotion tenderness
How is septic arthritis diagnosed?
arthrocentesis with synovial fluid cell cout/chem, graim stain, and culture
What is the treatment for non-gonococcal septic arthritis?
- joint drainage via needle aspiration OR surgical wash out
- IV broad spectrum antibiotics for 3-4 weeks
A 22-year-old male presents with a chief complaint of knee pain. His knee is red, hot, swollen, but he also has swollen finger and a non-pruritic/painless pustular rash on his hand. What is the most likely etiology?
a. staph aureus
b. gout
c. gonorrhea
d. lupus
e. chlamydia
c. gonorrhea
What is the most common pathogen causing non-gonococcal septic arthritis?
Staph Aureus
A patient presents with sudden onset left knee pain. The knee is swollen, warm and tender to palpation. The patient also note associated fevers and chills. What is the most likely diagnoses?
a. staph aureus
b. gout
c. gonorrhea
d. lupus
e. chlamydia
a. staph aureus
* non-gonococcal septic arthritis*
What is the classic triad of gonococcal septic arthritis?
- dermatitis
- tenosynovitis
- migratory polyarthritis
What is the treatment for gonococcal septic arthritis?
- culture everything you can
- IV antibiotics (Ceftriaxone 1g/day 1-2 weeks before tapering)
A 40-year-old male who is a brittle diabetic, peptic ulcer disease, presenting to urgent care with a sudden onset painful toe over the last 12 hours which feels like previous gout. Which of the following is the best medication to prescribe?
A. Colchicine B. Indomethacin C. Prednisone D. Allopurinol E. Probenecid F. Paracetamol
A. Colchicine
A 71-year-old female with a history of HTN, hyperparathyroidism, and obesity presents to the emergency department with acute swelling and pain in her right knee. She noted the onset of the pain and swelling over the past 24 hours. On examination, her right knee is hot, swollen, tender to palpation, and any joint movement of the left knee elicits significant pain. What is the most appropriate next step in management?
A. Send serum uric acid level B. Initiate colchicine C. Obtain plain film of the knee D. Perform arthrocentesis of the knee E. Provide IV antibiotics F. Send urine and throat gonorrhea antigen
D. Perform arthrocentesis of the knee
