Degenerative & crystal-induced arthropathies (obj 19) Flashcards
__% of all people have radiographic features of osteroarthritis in weight-bearing joints by age __.
90% of all people have radiographic features of osteoarthritis in weight-bearing joints by age 40.
If a patient with joint pain also has systemic symptoms, you know it can’t be _______.
can’t be osteoarthritis - osteoarthritis has no systemic symptoms
If a patient has joint pain with inflammation, you know it can’t be _______, but it could be ___________ (3).
can’t be osteoarthritis - osteoarthritis has no/minimal inflammation
could be RA, SLE, gout
If a patient has monoarticular joint pain, it could be ______.
If a patient has polyarticular joint pain, it could be ______.
monoarticular: osteoarthritis, gout, septic arthritis
polyarticular: RA, SLE
If a patient has joint pain at the DIP, it’s probably _______ and is not ________.
DIP = osteoarthritis
NOT RA
If a patient has joint pain at the wrists and metacarpophalangeal joints, it’s probably ________ and not _________.
wrist and knuckles = RA
NOT osteoarthritis
If a patient has joint pain at the first metatarsal phalangeal joint, your first thought is ______.
gout
Recreational running increases the incidence of osteoarthritis.
T/F
FALSE
competitive contact sports do though
bony enlargements at the DIP are called:
Heberden nodes
bony enlargements at the PIP are called:
Bouchard nodes
You palpate the knee of a patient complaining of knee joint pain. If it feels hard and cool, you think what? If it feels spongy and warm, you think what?
hard and cool = osteoarthritis
spongy and warm = RA
First-line therapy for osteoarthritis
acetaminophen
What is the conclusive diagnostic test result for confirming gout?
identification of urate crystals in joint fluid or tophaceous aspirate
First-line treatment for gout
NSAIDs
Your stereotypical gout patient
Male Pacific Islander over age 30
A nodular deposit of monosodium urate monohydrate crystals in cartilage, tendon, bone, etc.
tophus
Tophi usually develop with the initial attack of gout.
T/F
FALSE
Tophi usually develop years after the initial gout attack.
What are the differences between the crystals of gout and pseudogout?
gout crystals: monosodium urate monohydrate, negative birefringence
pseudogout crystals: calcium pyrophosphate, positive birefringence
Compare the radiographs of early and late gout.
early gout: no radiographic changes
late gout: punched-out erosions with overhanging rim of cortical bone (“rat bite”) next to a tophus
Treatment for asymptomatic hyperuricemia:
NO TREATMENT NECESSARY
First-line treatment for acute gout attack:
NSAIDs e.g. naproxen, indomethacin
______ is an appropriate treatment for acute gout attack, if the duration of the attack is < 36 hrs
colchicine
3 foods/drinks to avoid for patients with gout attacks
beer
organ meats
high fructose corn syrup
2 medications to avoid for patients with gout attacks
Thiazide and loop diuretics
Niacin
This drug reduces production of uric acid
allopurinol
This drug increases excretion of uric acid
probenecid
Your patient is having an acute gout attack but also has chronic kidney disease. What medications should you NOT use in this patient?
NSAIDs
colchicine
This drug enables humans to metabolize uric acid into allantoin (harmless substance)
pegloticase
You have a patient who you are seeing for the first time. He is a 65 year old man who says he has had 3 gout attacks in the past year and wants to know how to prevent them from happening again. His kidney function is fine. What do you do for him?
- medications to lower uric acid: allopurinol, febuxostat, probenecid, pegloticase
- avoid purine-containing foods: organ meats, beer, high fructose corn syrup
What is the difference in joints usually affected by gout and pseudogout?
gout: first metatarsal phalangeal joint
pseudogout: large joints esp. knees and wrists
