Gout Lupus Flashcards by Wendy Pitts

Gout (hyperuricemia) etiology

↑ serum uric acid (purine byproduct),
causes monosodium urate (needle crystals)
90% M >30 yo

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Primary Gout etiology

Overprdxn: idiopathic

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Secondary Gout etiology

Underexcretion (most common):
renal insuff, DM, alcohol, diuretics

Overprdxn: diet (↑ purine), enz defect, malig, drugs/alcohol

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Gout presentation

Rapid onset
Severe pain, red, swell
Pain peaks 8-12hrs
(U) big toe
(U) recurrent

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Gout ↑ chance of developing what?

kidney (renal) stones by 1,000x

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Stage 1 Gout

asym hyperuricemia (does us know good to know this since there are no symptoms)

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Stage 2 Gout

acute gouty arthritis:

triggered by acute Δ in uric acid (alcohol, diet, meds)

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Stage 3 Gout

Intercritical gout:
comes and goes
same triggers

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Stage 4 Gout

chronic tophaceous gout

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Gout tests

Arthrocentesis for culture
Micro analysis = negatively birefringent crystals
X-ray = “rat bite” joint erosion

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Gout tx: Acute attack

NSAIDS (Indomethacin)
address trigger
Colchince for prevention

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Gout tx: Long term

Goal = ↓ uric acid stores
Overproducers: Allopurinol
Underexcreters: Probenecid, Allopurinol

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Gout tx: Prophylaxis

Uricosurics: colchicine, NSAIDS

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Pseudogout etiology

synovitis from
calcium pyrophospate dihydrate crystals (CPPD)
(P) enz hyperactivity, genetics
(U) >65, M=F

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Pseudogout associated w/

Trauma or
things that ↑ Ca2+:
hyperparathy
hypothy
hypophos
osteo

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Pseudogout presentation

Acute onset of erythema, pain, swell in LARGER joints (U) knees

Self-limiting

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Pseudogout X-Ray findings

Ca2+ crystal deposits:

punctate, linear radiodensities in cartl, lig or capsules
osteophytes

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Pseudogout labs

synovial fluid = postively birefringent crystals

no serum study available

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Pseudogout tx

tx underlying cause
↓ pain: NSAIDS, steroid inject, ice pack
prophylax: colchicine

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Systemic Lupus Erythematosus (SLE)

etiology

antibody/antigen complexes in tissues

P) genetic, viral, bacterial (we don’t know

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SLE pathiophysiology

autoanti to nuclear and cytoplasmic antigens destroy cells ->

chronic inflamm of:
skin, joints, kidney, lungs, NS, blood cells

SLE epidemiology

F:M = 7:1
black F 4x more
(U) onset in 20s

SLE presentation

Variable:
viral-type sxs
joint pain (U) PIP, MCP, wrist, knees
malar rash (butterfly) on nasolabial folds
discoid rash on sun-exp areas

Need at least how many criteria from SLE chart for + diag?

Classifications of SLE (4)

``` Classical = many criteria Definite = >=4 Probably = 3 Possible = 2 ```

Raynaud's Phenomenon is?

finger tips turn white/blue vasospastic disease comes/goes (P) indication of SLE

SLE tests

tests are sensitive but not specific Antinuclear antibody (ANA) Erythrocyte Sedimentation Rate (ESR)

SLE tx

By severity: NSAIDS Refer to rheum for: antimalarials, cortster

Lupus Nephritis tx

cyclophosphamide | methylprednisone

Tx for CNS involvement in SLE

antipsych, anticonvulsants

Tx for Thrombosytopenia in SLE

corticosteroids

Tx for Antiphospholipid Antibodies in SLE

anticoag w/ warfarin/heparin + asprin

Drug-induced SLE epidemiology

drug-induced autoantibodies don't necessarily result in SLE, common in slow acetylators, M=F, old white people

Drug-induced SLE presents

viral-like sxs, joint pain | (U) taking new drug for >= 1mo

Drug-induced SLE tests

positive ANTI-HISTONE antibodies | negative anti-dsDNA, anti-Sm

Drug-induced SLE tx

stop offending drug | steroids

Drug-induced SLE: most common offending drug

procainamide

SLE prognosis

variable relapse/ remit renal & CNS involvement = poor prog infection causes ~30% of deaths 10yr survival >90%

Sjogren's Synd etiology

systemic auto-imm disorder idiopathic or assoc'd w/ SLE or RA results in chronic dyfxn of exocrine glands

Sjogren's Synd epidemiology

F:M = 9:1 | (U) diag @ 40-50 yo

Sjogren's Synd presentation

``` sicca sxs (↓ tears, saliva) - sets this apart from SLE, RA (P) other SLE/RA-like sxs ```

Sjogren's Synd tests

``` RF = + ANA = + CBC = (P) anemia of chronic disease ```

Sjogren's Synd tx

saliva and tear replacement drops | NSAIDS

Scleroderma etiology

auto-imm disease thickening the skin, F>M onset 20-50 yo

Systemic Sclerosis etiology

auto-imm disease thickening organs/connect tissue, vascular Δs in small bv F>M onset 20-50 yo

CREST is?

limited subtype of scleroderma/systemic sclerosis ``` Calcinosis cutis Raynaud's Esophageal ↓ motiility Sclerodactyly Telangestasia ```

Diffuse scleroderma/systemic sclerosis

worse prognosis than CREST | same as CREST + trunk and proximal extremities

Scleroderma/Systemic Sclerosis presentation

``` Polyarthralgias Raynaud's Pigment Δ Dysphasia Respiratory Cardiac Renal ```

Scleroderma/Systemic Sclerosis tests

ANA = + | Anti-centromere antibodies (ACA)

Scleroderma/Systemic Sclerosis tx

Raynaud's: Ca2+ chan block Esophageal: H2 block, proton pump inhib Renal: ACE inhib