Arthritis and Gout Flashcards
Oligo-articular involves how many joints?
2-4
Poly-articular involves how many joints?
> 5
red, swelling, heat, pain are indicative of
joint inflammation
(inflammatory/non-inflammatory) joint pain is WORSE in the morning, but IMPROVES with activity
Inflammatory (septic, RA, gout, SLE)
(inflammatory/non-inflammatory) joint pain is okay in the morning, but WORSENS with activity
Non-inflammatory (osteoarthritis, trauma)
ACUTE monoarthritis can be indicative of
Septic arthritis
Gout
Arthrocentesis is aka
joint aspiration
(lightly cloudy/tea/white) colored synovial fluid is indicative of osteoarthritis
lightly cloudy
(cloudy/tea/white) colored synovial fluid is indicative of inflammatory arthritis
Tea
(cloudy/tea/white) colored synovial fluid is indicative of septic arthritis
White
Gout as a monoarthritis most often involves 1st
MTP joint
Joint pain due to loss of normal articular cartilage with age, trauma, and obesity; pain worsens with activity; associated with popliteal cysts, DIP/PIP joints and 1st CMC joint
Osteoarthritis
X-ray characteristics of Osteoarthritis
- Osteophytes (bony lumps on vertebrae)
2. Joint space narrowing (wearing of joint cartilage)
The crystal involved with Gout is
Monosodium Urate Crystals (needle shaped and strongly negatively birefringent)
Acute monoarthritis due to deposition of monosodium urate crystals in the joints; more common in men; Hyperuricemia is ESSENTIAL for the development
Gout
Obesity, diabetes, alcohol and some medications (aspirin, diuretics, etc.) are the risk factors for
Gout
Hyperuricemia causing Gout is majorly due to (overproduction/under-excretion) of uric acid
underexcretion
Hyperuricemia is defined as a serum urate level…
> 7 mg/dL
Acute monoarthritis in Gout usually involves which joint?
1st MTP
Nodular masses of uric acid crystals deposited in different soft tissue areas of the body; most commonly at the fingers, at the tips of the elbows, and around the big toe
Tophus gout (chronic)
Synovial fluid analysis is the ONLY definitive diagnosis for Gout as it will be inflammatory (>5k WBCs) (True or False)
True
What characteristics of synovial fluid will indicate Gout
WBC >5k
+ Urate crystals (under polarized light)
Treatments for Gout
Acute: NSAIDs, steroids, colchicine
Chronic (preventative): Allopurinol (xanthine oxidase inhibitor)
Function of colchicine
Inhibits tubulin in microtubules –> inhibits neutrophil fx
Doesn’t alter urate levels though!!
Pentose phosphate Pathway produces what byproducts?
- Ribose-5-Phosphate
2. PRPP
What is the major regulating step for purine synthesis and its enzyme?
Conversion of PRPP –> 5-phosphoribosyl 1-amine
- GPA (Glutamine Phosphoribosyl Amidotransferase)
Examples of Xanthine Oxidase Inhibitors
Allopurinol
Febuxostat
Adenine, Hypoxanthine, and Guanine are purine bases that all require what in the salvage pathway to make nucleotides?
PRPP
Adenine uses APRT to make AMP, while Hypoxanthine and Guanine use _____ to make IMP, GMP
HGPRT
Glucose 6-phosphatase deficiency, lesch-nyhan syndrome, tumor lysis syndrome, PRPP excess, and von gierke disease (type I glycogen storage disease) can cause hyperuricemia through
Overproduction of uric acid
X-linked recessive; HGPRT deficiency disorder; buildup of Hypoxanthine and Guanine –> degradation into uric acid
Lesch-Nyhan Syndrome
the destruction of tumor cells releases tons of nucleic acids, stimulating degradation and uric acid production
Tumor Lysis Syndrome
In excessive alcohol consumption and type 2 diabetes, excess lactic acid production competes with _____ leading to Gout
uric acid
“Pseudogout”; deposition of Calcium Pyrophosphate crystals in joints; rhomboids/pleomorphic, weakly + birefringent; more knee involvement (vs. MTP in gout)
Calcium Pyrophosphate Deposition (CPPD)
aging and metabolic disturbances (Hyperparathyroidism, Hemochromatosis/iron overload) are risk factors of
CPPD
Tx for CPPD
NSAIDs
Steroids
Colchicine
- same as acute gout
A chronic autoimmune inflammatory disease; SYMMETRIC inflammatory POLYarthritis affecting proximal small joints in hand/foot; mediated by macrophages, cytokines, and MMPs; women are affected more; associated with HLA-DRB1 gene, Parvo/EBV viruses
Rheumatoid Arthritis
Gene associated with Rheumatoid Arthritis
HLA-DRB1 gene
Cytokine important for Rheumatoid Arthritis; produced mainly by MONOCYTES and MACROPHAGES
TNF-a
Rheumatoid arthritis usually involves (proximal/distal) hand and foot joints
Proximal (wrist, MCP, ankle, and MTP joints)
Osteoarthritis usually involves (proximal/distal) hand and foot joints
Distal (PIP, DIP)
- exception 1st CMC joint
What are some other organ complications of RA?
- CAD (cardiology)
- Nodules (dermatology)
- Interstitial lung disease
- Sjogren’s syndrome (decreased tear and salivary production)
Common autoantibodies for Rheumatoid Arthritis
- Rheumatoid factor
- anti-cyclic citrullinated protein (anti-CCP) antibody
- anti-CCP is most specific diagnosing antibody
an antibody against the Fc portion of IgG
Rheumatoid Factor (anti-IgG antibody)
Radiographic features of Rheumatoid Arthritis
- Periarticular osteopenia
- Joint space narrowing
- Erosion of bone (looks spongy)
Treatments for Rheumatoid Arthritis
Disease-modifying agents (Methotrexate)
Biologics (TNF-a inhibitors–> Adalimumab)
Corticosteroids (short-term)
A group of arthritis without rheumatoid factor; includes PAIR; associated with HLA-B27 gene
“Seronegative” Spondyloarthritis
Antibodies NOT detected
PAIR include what types of arthritis
Psoriatic arthritis
Ankylosing spondylitis
IBD (UC/chron’s)
Reactive arthritis
Common signs/symptoms of Seronegative Spondyloarthritis
- Back pain
- Peripheral arthritis
- Enthesitis (inflammation of tendons–> achilles)
- sausage fingers
Gene associated with PAIR arthritis
HLA-B27
Arthritis associated with psoriasis; nail lesions (onycholysis)
Psoriatic Arthritis
Arthritis associated with fusion of SI joints and vertebrae; bamboo spine on x-ray; more in males
Ankylosing Spondylitis
Arthritis associated with Inflammatory Bowel Diseases; usually presents with GI symptoms + skin symptoms
Enteropathic Arthritis
Arthritis associated with triad (conjunctivitis, Urethritis, Arthritis); follows a recent bacterial infection (yersinia/chlamydia/salmonella)
Reactive Arthritis
Can’t see, can’t pee, can’t bend my knee
What virus has been implicated in RA and SLE (both are autoimmune disorders)?
Parvo B19
Osteoarthritis will involve (bony/spongy) enlargements of joints while Rheumatoid Arthritis will involve (bony/spongy) enlargements
OA: bony
RA: spongy