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