Gout & SLE - 405

Question 1

gout

Answer 1

a disruption in uric acid metabolism that caues deposits of urate salts in certain tissues (such as in or around the joints)

Question 2

gouty arthritis

Answer 2

-urate crystals in synovial fluid
-acute, painful inflammation

Question 3

chronic tophaceous gout

Answer 3

advanced stage of gout w/ the development of tophi (small white nodules composed of urate crystals that can be see upon assessment)

Question 4

gouty arthritis is caused by

Answer 4

-increase uric acid production
-decreased uric acid excretion in the kidneys
-increased intake of foods containing purine
-drug induced (secondary GA)

Question 5

modifiable risk factors of gout

Answer 5

hyperuricemia, obesity, hypertension, hyperlipidemia, CV disease, DM, CKD, dietary factors, alcohol, meds

Question 6

gouty arthritis CM

Answer 6

-pain (intense, mornings, great toe)
-cannot have anything touch where the pain is
-inflammation: edema, tenderness, redness
-fever & malaise
-peaks at 24-48hrs, takes 5-10 days for flare to end

Question 7

are tophi painful

Answer 7

no but cause body image disturbance and impairs use of hands

Question 8

increase in weight gain causes

Answer 8

increase in gout
if overweight w/ gout: kcal restriction, inc protein, complex carbs & dec sat fat + dec sugar sweetened bevs & avoid flare foods like fatty meals, organ rich foods, beer and distilled spirits

Question 9

recommendations for people w/ gout

Answer 9

1) lose wt
2) take meds
3) eat recommended diet

Question 10

dx of gout

Answer 10

-elevated uric acid
-24 hr urine collection (can tell what is cause)
-synovial fluid tested (gold standard but rarely done)

Question 11

gout collaborative care

Answer 11

-address modifiable risk factors
-pain control & joint immobilization during flares
-encourage fluids
-drug therapy (primary therapy)

Question 12

gout drug therapy

Answer 12

acute: colchicine (dramatic relief within 12-24 hrs) & NSAIDs
prophylactic: allopurinal (2-6wk onset)

Question 13

lupus

Answer 13

an autoimmune, multisystem inflammatory disease that is chronic w/ unpredictable remissions & exacerbations of flares

Question 14

who is most affected by lupus

Answer 14

females ages 20-40
+genetic, hormonal, environmental & immunologic in origin
+AA

Question 15

lupus typically affects

Answer 15

skin, joints, serous membranes, + renal, hematologic & neurologic systems

Question 16

lupus CM

Answer 16

-joint pain (earliest sx): fingers, wrists & knees
-dont feel well for awhile but dont know why
-polyarthralgia in the morning
-pain & stiffness moves through body and usually doesn’t affect both sides in the same way
-joints are swollen and warm
-photosensitivity + butterfly rash
-lupus nephritis w/n 5yrs & lupus cerebritis
-anemia, thrombocytopenia, mild leukopenia
-unexplained fever
-extreme fatigue
-raynauds phenomenon

Question 17

lupus CM (objective cues)

Answer 17

-unusual hair loss
-edema in legs or around eyes
-ulcers of mouth & nose
-pleurisy & pericarditis
-diff concentrating, confusion
-depression
-headaces
-seizures
-finger deformities

Question 18

dx of lupus

Answer 18

-H&P
-no specific test
-ANA is positive in almost all patients
-anti DNA is most specific to lupus
-elevated inflamm markers
-serum complement decreased
-CBC: low RBC, WBC & platelets
-urine: proteinuria, hematuria, blood cell casts (indicating kidney involvement)

Question 19

lupus drug therapy

Answer 19

very individualized
hydroxychloroquine (almost all will be on) + NSAIDs & short term steroids (<7.5 mg/d)

Question 20

drug therapy if severe lupus

Answer 20

intensive immunosuppressants (methotrexate) & high dose steroids to halt issue injury

Question 21

lupus triggers

Answer 21

-ultraviolet light / sunlight
-abruptly stopping drug therapy
-avoid infections

Question 22

psychosocial issues r/t lupus

Answer 22

-pain & fatigue
-chronicity
-pregnancy/sexual counseling
-body image disturbances