Gout, Pseudogout, and Lupus diagnosis and treatments Flashcards
What are three differential diagnoses for acute monoarticular athritis?
Septic joint caused by gonococcal bacterium (younger age groups), nongonococcal bacterium (#1 is staph aureus, these are the most destructive types), or crystalizing arthritis (gout or pseudogout)
What is the primary drug of choice for prevention for someone who is an over-producer of uric acid?
AllOPurinol (OP=over producer), Febuxostat is a new and $$$$ drug that is easier on renal function
What is the primary drug of choice for someone who is an under-excreter of uric acid?
Probenecid (watch dosing)
What is the gold standard for gout diagnosis? What does it reveal?
arthrocentesis (r/o infectious cause), reveals negatively birefringent monosodium urate crystals
How is a serum acid level used in the treatment of gout?
levels are high in 95% of people with gout (highly specific), but only 15-20% of patients with high serum acid levels will develop gout
What radiographic finding is present in gout?
“rat bite” appearance signifying joint erosion
What levels of uric acid are needed to treat asymptomatic gout?
> 11mg/dL
What three stages is gout treated in?
1) treatment of acute attack 2) prophylaxis to prevent future flares 3) elimination of excess stores
What is the first line treatment of an acute gout attack in an otherwise healthy patient?
Indomethacin– MANY SIDE EFFECTS
What is the second line treatment for an acute gout episode?
intra-articular steroid injections (make sure infection is r/o)
How is Colchicine used for gout?
As a prevention, sometimes as a second line treatment IN A LOW DOSE
What crystals are involved in pseudogout?
Calcium pyrophosphate dihydrate (positively birefringent)
What age group is most susceptible to pseudogout?
The elderly
What is the clinical presentation of gout?
acute onset of erythema, pain, and swelling in the large joints (knees are 50%)
What is the primary treatment for pseudogout?
symptomatic with NSAIDs, ice, and steroid injections, Colchicine (+/- in elderly)
What is the best differentiation between gout and pseudogout?
Gout is primarily in men over age 30 and postmenopausal women, primarily big toe. Pseudogout is primarily in the elderly, primarily knee.
What are the two most common clinical presentations of lupus?
Malar (butterfly rash) or Discoid (erythematous patch with keratotic scaling in sun-exposed areas)
What are some other clinical manifestations of lupus?
Non-specific fever, wt loss, anemia, RAYNAUD’S PHENOM (white, blue, red), recurrent fetal loss
What two tests should a PA order to diagnose lupus?
ESR and ANA (in 95% of people with SLE)
You get a positive ANA. Which one (of the three tests should a rheumatologist order to diagnose lupus) should be ordered first?
1) Anti-ds-DNA or anti-Smith antibodies, anti-phospholipid antibodies is alternate
What is the treatment for lupus?
Dependent on severity of dz.
For lupus nephritis: cyclophosphamide and methylprednisolone
For CNS involvement: antipsychotics and anticonvulsants
For thrombocytopenia: corticosteroids and Igs
For antiphospholipids: warfarin and heparin or ASA for anticoag
What lab test is unique for drug-induced lupus?
anti-histone antibodies, d/c drug and use steroids to treat
What are the clinical presentations of Sjorgen’s Syndrome?
dry eye and dry mouth, recurrent parotiditis, some arthralgias
What labs will be positive in Sjorgen’s Syndrome?
RF, ANA, normocytic normochromic anemia
How will a rheumatologist treat Sjorgen’s Syndrome?
Artificial tears (cyclosporin), NSAIDs, Immunosuppressive agents
What are the names for generalized autoimmune disorders that affect the connective tissue cutaneously and viscerally (respectively)?
Scleroderma and systemic sclerosis
What does CREST stand for and what disease is it indicative of?
Calcinosis cutis, Raynaud’s phenom, Esophageal motility, Sclerodactyly, Teleangiectasias; scleroderma
What lab tests may be positive in scleroderma?
ANA, ACA (anti-centromere),
What is the primary treatment for Raynaud’s phenom?
CCBlockers
What treatments are used in esophageal disease in scleroderma?
H2 blockers, proton pump inhibitors, and small, frequent meals.
What drugs are used to treat renal disease in scleroderma?
ACE inhibitors (treat aggressively)
