gout + lupus

Question 1

gout

Answer 1

inflam disease from deposits of uric acid crystals in tissues and fluids w/n body
disease of kings -> associated with rich people food - smoked meats and cheeses, red wine, beer)

Question 2

gout: patho

Answer 2

uric acids from breakdown of purines -> nitrogen
body makes purine, normally dissolves in blood and excreted by kidneys

Question 3

uric acid foods

Answer 3

organ meats, shellfish, anchovies, herring, asparagus, mushrooms

Question 4

gout: etiology

Answer 4

hyperuricemia
increased production of uric acid, decreased excretion of uric acid

Question 5

gout: rf

Answer 5

obsese, M, AA, increased meat and seafood, diuretics, OH (beer and spirits)
pre-existing diseases - htn, DM, renal, sickle cells

Question 6

gout: phase 1

Answer 6

asymp but with increased serum uric acid levels and deposits in tissues
crystals accumulate and tissue is damaged -> triggers acute inflam

Question 7

gout: phase 2

Answer 7

acute flares or attacks occur -> hyperuricemia s/o inflam

Question 8

gout: phase 3

Answer 8

clinically inactive until next flare -> continued hyperuricemia
may be months or yrs before next flare, later recurring attacks get closer and closer together

Question 9

gout: phase 4

Answer 9

chronic arthritis = joint pain and other s/s present most of the time

Question 10

gout: cm

Answer 10

present days = wks
pain: mild or excruciating, usually LE -> cant even touch bed sheets
burning, redness, swelling and warmth, fever
mostly big joint

Question 11

gout: complications

Answer 11

NSAIDs
tophi: large hard nodules composed of uric acid crystals deposited in soft tissue - may form below skin around joints, can cause local inflam response, may drain chalky material
renal calculi -> kidney stones

Question 12

gout: pharm

Answer 12

goals: decrease s of acute attack and prevent recurrent
NSAIDs 1st line
allopurinol, colchicine, probenecid

Question 13

lupus

Answer 13

systemic lupus erythematous (SLE)
patho: B lymph are hyperactive and produce antibodies -> autoimmune -> activated against DNA (deposit in DNA)
ANA = antinuclear antibody -> we can measure this
form immune complexes that circulate around body and can target any major organ system (commonly kidney)
immune complexes trigger inflam and destroy organs

Question 14

lupus: rf

Answer 14

genetic, F, 20 - 40, AA, env/triggers (sun), allergy to abx, hormonal factors (immune S - oral contraceptives, early menstruation), tobacco

Question 15

lupus: cm

Answer 15

every organ system, s/s endless
extreme fatigue, photosensitivity, butterfly rash (bilateral, face), fever, edema (face/eyes), weight change, unusual hair loss, raynayd’s

Question 16

lupus: cm - CNS

Answer 16

HA, dizzy, seizures, stroke

Question 17

lupus: cm - lungs

Answer 17

pleuritis, pleural effusions

Question 18

lupus: cm - heart

Answer 18

myocarditis, endocarditis

Question 19

lupus: cm - kidneys

Answer 19

nephritis

Question 20

lupus: cm - BV

Answer 20

vasculitis

Question 21

lupus: cm - blood

Answer 21

anemia, leukopenia, thrombocytopenia, blood clots

Question 22

lupus: cm - joints

Answer 22

arthritis

Question 23

lupus: flares

Answer 23

acute exacerbation of S
exacerbations and remission
warning S = fatigue, pain, HA
prevent = recognize warning and avoid trigger
triggers = sunlight exposure, infection, abruptly stopping med, stress

Question 24

lupus: pharm

Answer 24

control S -> depends on systems involved!
NSAIDs: HA, MS, pleuritis, pericarditis
high dose corticosteroids: severe KD, CNS
low dose corticosteroids: arthritis
antimalarials (hydroxychloroquine): skin, MS, prevent kidney and CNS organ damage
immunosuppressants (methotrexate): severe organ involvement

Question 25

RA and SLE: commonalities

Answer 25

autoimmune, systemic inflam, multiple body s, pharmacotherapy

Question 26

RA and SLE: major dif

Answer 26

RA = mostly joints (sometimes organs)
SLE = multisystem (sometimes joints)