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Clin Med 1 > Gout, SLE, arthritis, etc > Flashcards

Gout, SLE, arthritis, etc Flashcards

0
Q

Gout epidemiology

A

middle aged and elderly men, post-menopausal women

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1
Q

deposition of uric acid crystals in joints and connective tissue due to overproduction or underexcretion of uric acid

A

Gout

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2
Q

rapid onset, pain peaks w/in 8-12 hours.
Pain, redness, and swelling, usually in smaller lower extremity joints
Often recurrent

A

Gout

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3
Q

Stage 1 of Gout is?

A

acute gouty arthritis, triggered by acute change in uric acid
can resolves on its own w/t tx

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4
Q

Stage 2 of gout is? (3)

A

“intercritical gout”
intermittent attacks, same triggers
deposits in soft tissues as well

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5
Q

Stage 3 of Gout is?

A

chronic recurrent and tophaceous gout

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6
Q

Gout triggers (2+ and expand)

A

EtOH use

High purine consumption: organ meats, anchovies, mushrooms, spinach, asparagus, cauliflower, beans, seafood, peas

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7
Q

labs for gout? (4)

A

arthrocentesis, microscopic analysis
increased serum uric acid level
24h urinary uric acid secretion
radiography- joint erosions

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8
Q

Gout findings on mcroscopic analysis?

A

monosodium urate crystals that are negatively bifringent

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9
Q

Gout: 24h urine uric acid results?

A

> 800 mg/dL for overproducers

< 700 mg/dL for underexcreters

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10
Q

Gout tx (4)

A
  1. NSAIDs
  2. intra-articular steroids, oral steroids
  3. Colchicine- prophylaxis
  4. Uricosuric agents
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11
Q

Gout meds for underexcreters (2)

A

Probenecid 250mg BID

Allopurinol (Zyloprim) 100mg daily

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12
Q

Most common gout med?

A

Allopurinol (Zyloprim)

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13
Q

Gout meds for overproducers (2)

A

Febuxostat- Xanthine Oxidase inhibitor

Allopurinol

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14
Q

acute onset of erythema, pain, & swelling in the larger joints: knees, wrists, MCPs, hips. Attacks may be self-limiting

A

Calcium pyrophosphate dihydrate deposition disease (CPPD)

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15
Q

CPPD etiology

A

unknown

can be increased by trauma

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16
Q

CPPD labs and imaging findings (3)

A

Radiographic changes- Evidence of Ca2+ crystals- punctate and linear radiodensities in joint areas
Elevated neutrophils on CBC
Microscopic study

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17
Q

CPPD findings on microscopic study

A

positively birefringent rhomboid-shaped crystals

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18
Q

CPPD tx (3)

A
  1. NSAIDs
  2. colchicine 0.6 mg BID during acute inflammation
  3. removal of crystals by joint aspiration, intra-articular steroid injection
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19
Q

autoantibodies to nuclear & cytoplasmic antigens destroy cells –> tissue damage

A

Systemic Lupus Erythematous

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20
Q

fever, fatigue, joint pain, rash, weight loss, anemia, Raynaud’s
photosensitivity, polyarthritis, renal disorders, heme disorders, mucosal ulcers, serositis, neuro disorders

A

SLE

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21
Q

Raynaud’s phenomenon is?

A

Triphasic circulatory response in hands

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22
Q

SLE labs are? (7)

A 
Sed rate
Antinuclear antibody (ANA)
(+) Anti DNA antibody
(+) anti-Smit antibody
(+) anti-phospholipid antibody
urinalysis for renal damage
liver tests
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23
Q

SLE tx? (5)

A 
decrease sun exposure
NSAIDs (Naproxen, Celecoxib)
Antimalarials (Hydroxychloroquinine, Plaquenil)
Corticosteroids
Immunosuppressive drugs for severe cases
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24
pt on medication w/ arthralgia, myalgia, malaise, fever, rash, serositis
Drug Induced SLE
25
labs for drug induced SLE (2)
+ antihistone antibodies | - anti-dsDNA & anti-Smith
26
drug induced SLE tx
discontinue drug, consider steroids
27
"Sicca syndromes"? and what do they indicate?
xerostomia, dry eyes, recurrent parotiditis Sjögren's syndrome
28
dry eyes/mouth, recurrent parotiditis, Raynaud's phenomenon, myalgia, pulmonary disease, anemia, leukopenia, vasculitis, GI disease, arthritis
Sjögren's syndrome
29
Sjogren's labs? (4)
+ RF, + ANA Anti-Ro/SS-A, Anti-LA/SS-B (Primary Sjogrens) Anti-SS-C (Sjogrens related to SLE/RA) Schirmer's test for tear production
30
Sjogren's tx? (3)
saliva & tear replacement NSAIDs for arthralgias steroids/immunosuppressants for severe cases
31
diffuse fibrosis of the skin & internal organs
Systemic Sclerosis/Scleroderma
32
overall tightening and thickening of tissues, narrowing of the small vessels
Scleroderma
33
CREST syndrome:
``` Calcinosis cutis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias ```
34
Limited cutaneous scleroderma symptoms?
CREST syndrome
35
CREST + GI tract (weight loss), lungs (pulmonary fibrosis, pulm. HTN), renal failure, myocardial fibrosis
Diffuse cutaneous scleroderma
36
polyarthralgias, Raynaud's phenomenon, pigmentation changes, dysphagia, respiratory symptoms, cardiac symptoms, renal crisis
Scleroderma
37
Labs for scleroderma
(+) ANA Anti-centromere antibodies (ACA) anti-SCL-70 (Scleroderma antibody)
38
Scleroderma tx (3)
Symptomatic: Raynaud's- Ca2+ channel blockers (Nifedipine) Esophageal disease (H2 blockers, PPIs, smaller meals) Inhibitors for renal disease
39
arthritis that occurs following an infection
Reactive arthritis
40
reactive arthritis etiology
GI or GU organisms- Chlamydia is the most common
41
Reiter's triad
postinfectious arthritis urethritis conjunctivitis
42
Reiter's trad, prior sxs of diarrhea or urethritis, asymmetric knee swelling, arthritis of hands, mucosal ulcers,nail changes, genital lesions, lesions on bottom of foot
Reactive arthritis
43
lesions on bottom of foot w/ reactive arthritis
keratoderma blennorrhagicum
44
labs for reactive arthritis (5)
``` ESR, CRP + HLA-B27 Antigen - RF antibody - ACC antibody arthrocentesis on affected joint- r/o other conditions ```
45
Reactive Arthritis first line tx (3)
NSAIDs: Indomethacin 50mg TID-QID Naproxen 500mg BID-TID Diclofenac 50 mg TID
46
Reactive arthritis 2nd and 3rd line tx (2)
2. steroids: intra-articular or systemic steroids | 3. biologic agents: sulfasalazine, methotrexate, TNF inhibitor
47
symmetric polyarthritis, morning stiffness > 1hr, pain & swelling at affected joints, synovial hypertrophy
Rheumatoid arthritis
48
early sites of rheumatoid arthritis (4)
MCP & PIP joints of fingers IP joints of thumbs wrists MTP joints of toes
49
later findings of rheumatoid arthritis (5)
``` ulnar deviation of MCP Boutonierre deformity of PIP Swan neck contractures (DIP flexion) rheumatoid nodules decreased ROM at elbow, hip, knee ```
50
signs of systemic disease in rheumatoid arthritis (3)
rheumatoid nodules, episcleritis, atlantoaxial subluxation
51
imaging findings for rheumatoid arthritis (purpose + 4)
Establish baseline of affected joints | soft tissue swelling, osteopenia, decreased joint space, subluxation/dislocations
52
rheumatoid arthritis labs
ESR, CRP, CBC (anemia in chronic disease) RF for prognostic value + Anti-CCP antibodies (there are seronegative pts.)
53
highly specific lab findings for rheumatoid arthritis
+ RF | + Anti-CCP antibodies
54
rheumatoid arthritis non-pharm tx
Preventative- exercise, nutrition, smoking cessation
55
rheumatoid arthritis pharm txs
DMARDs: Methotrexate, sulfasalazine NSAIDs glucocorticoids biologic agents: TNF-a, IL-1, IL-6
56
epidemiology of Juvenile Idiopathic Arthritis (JIA)
< 16 y/o, M=F
57
<5 joints involved at first, large joints may be swollen, tender, warm, w/out erytheme, uveitis
Pauciarticular (Oligoarticulr) JIA
58
lab findings for pauciarticular JIA (2)
+ ANA | - RF
59
Pauciarticular JIA tx
NSAIDs or intra-articular glucocorticoids | refer to Opthalmology for uveitis
60
fever, rash, arthritis, LAD in pt <16 y/o
Systemic JIA
61
lab findings for systemic JIA (4)
elevated ESR, CRP leukocytosis anemia thrombocytosis
62
Systemic JIA tx
NSAIDs | glucocorticoids & DMARDs for severe disease (high fever, pain)
63
indications for tx of systemic JIA w/ glucocorticoids and DMARDs
high fever, pain
64
> 4 affected joints during the 1st 6 mo. of illness, pt <16 y/o
polyarticular JIA
65
polyarticular JIA epidemiology
peaks 2-5, 10-14 y/o | F>M
66
indolent polyarthritis in younger children, more rapid onset in adolescents Flexion contractures & weaknesses, bony erosions & joint destruction
Polyarticular JIA
67
labs for polyarticular JIA (4)
may or may not have RF elevated ESR anemia + ANA
68
polyarticular JIA tx
NSAIDs DMARDs Optional: glucocorticoids (systemic/intra-articular), physical therapy
69
characteristic radiologic finding of rheumatoid arthritis
obliteration of the joint
70
degeneration of cartilage & bone hypertrophy at articular margins
osteoarthritis
71
pain exacerbated by activity, helped w/ rest. Morning stiffness >30 min. Fingers, knee, hip, and spine are affected
Osteoarthritis
72
Heberden's nodes affect?
DIPs
73
Bouchard's nodes affect?
PIP
74
Heberden's nodes, Bouchard's nodes, 1st MCP, knee osteophytes/crepitus, decreased ROM at joints, hip pain referring to knee
osteoarthritis
75
in OA, hip pain may refer to
knee
76
OA of the spine
cervical or lumbar spondylosis | Degenerative Disc Disease
77
complications of lumbar spondylosis
spinal stenosis, slipping over the disc
78
OA lab findings
All normal- X-ray more helpful
79
diagnosis of OA is made how?
presence of typical symptoms physical exam normal labs imaging features
80
nonpharm OA txs
exercise, weight loss, rest, physical therapy
81
pharm tx for OA (4)
1st line: Tylenol NSAIDs topical NSAID or capsaican intra-articular glucocorticoids
82
surgical tx for OA and indication
Failed other Txs | joint replacement, joint resurfacing
83
widespread chronic musculoskeletal pain. Joint pain, swelling (but not present on exam), paresthetias. Fatigue Secondary: headache, abd/chest wall/pelvic pain
Fibromyalgia
84
morning stiffness or tiredness. Decreased attention span. Possible depression/anxiety
Fibromyalgia "fibro fog"
85
Diagnostic findings for fibromyalgia?
bilateral tender points
86
diagnosis of fibromyalgia based on?
11/18 tender points- positive, reproducible
87
nonpharm fibromyalgia tx: (5)
education, treat mood disorders (psych), exercise program, physical therapy, trigger point injection
88
pharm tx for fibromyalgia: (5)
Tricyclic antidepressant- Amitriptyline Muscle relaxants: Flexeril SNRIs: Duloxetine (Cymbalta), Milnacipran (Savella) Pregabalin (Lyrica), Gabapentin (Neurontin) SSRIs, NSAIDs, Tramadol (Ultram)

Clin Med 1 (18 decks)

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