Class 7 (2/18/21) Part 1

Question 1

GOUT

Gouty Arthritis = Crystal Induced Athropathy

Answer 1

• Excessive blood level of uric acid
• Excess uric acid can forming sharp, needle-like crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
• Recurrent attacks of acute arthritis in which urate crystals are found in synovial fluid.
• Tophi: Aggregates of urate crystals (tophi) deposited in tissue

Question 2

Uric acid

Answer 2

• It is waste product formed from the breakdown of
  purines
• Purine Foods: Beer, other alcoholic beverages. Organ meat (liver, kidneys, …)

Question 3

Risk factors of GOUT

Answer 3

• Lifestyle: Alcohol Consumption, Diet high in animal proteins, Body Weight
• Genetic & age (between the ages of 30 and
  50) , gender (more in men)

Question 4

PRESENTATION of gout

Answer 4

• Acute Gouty Arthritis
• Tophi
• Kidney Stones

Question 5

Acute Gouty Arthritis

Answer 5

• Intense Pain !!
• Monoarticular arthritis is the initial presentation of gout in 90% of patients.
• Gout typically affects the large joint of the big toe – Podagra is the name for this.
• Pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.

Question 6

Tophi

Answer 6

• Tophi are collections of uric acid crystals in the
  soft tissues.
• Finding tophi during the first episode of gout is unusual; they tend to develop after 10 years in untreated patients who develop chronic gouty arthritis.

Question 7

SCREENING AND DIAGNOSIS of gout:

Answer 7

• Synovial Fluid Aspiration and Examination

- Uric acid in 24-hour urine sample

Question 8

TREATMENT of gout

Answer 8

(1) treating the acute attack
(2) providing prophylaxis to prevent acute flares
(3) lowering excess stores of uric acid to prevent flares of gouty arthritis and to prevent tissue deposition of uric crystals

Question 9

Acute Attack of GOUT

Answer 9

• NSAIDs -> Indomethacin
• Colchicine: the classic medication for gout and can ease joint pain.
• Allopurinol - Reduces production of uric acid
  • Prednisone

Question 10

PREVENTION of gout

Answer 10

• Maintain a healthy weight
• Avoid excessive amounts of animal protein.
• Limit or avoid alcohol
• Drink plenty of liquids

Question 11

PSORIATIC ARTHRITIS

Answer 11

• Psoriatic Arthritis is a form of inflammatory arthritis associated with psoriasis
• Key Features: DIP Involvement, Nails are involved, Symmetrical polyarthritis, “sausage” appearance (dactylitis).

Question 12

PSORIATIC ARTHRITIS vs RA

Answer 12

It is differentiated from RA by:
- Distal Interphalangeal (DIP) joint involvement
- The absence of subcutaneous nodules 
- Negative test result for rheumatoid
factor (RF).

Question 13

LAB STUDIES of psoriatic arthritis

Answer 13

• Elevated ESR & CRP

- Anemia

Question 14

Treatment of psoriatic arthritis

Answer 14

• NSAIDs
• DMARDs
  • Methotrexate
  • Cyclosporine
  • Sulfasalazine