Gout & Spondyloarthridities Flashcards
How does gout appear in polar microscopy?
Negatively birefringent crystals
What is the treatment for gout?
NSAID’s first line - eg. Naproxen
If NSAID’s contraindicated then Colchicine can be used.
Allopurinol can then be used for prophylaxis following an acute attack
How would you diagnose gout?
You would carry out a urate blood test - if this was elevated this would point towards the diagnosis
Gold standard diagnosis is a joint aspiration that you would examine via polarised light microscopy
What are the four different types of spondyloarthridities?
“PEAR”
1) Psoriatic arthritis
2) Enteric arthropathy
3) Ankylosing spondylitis
4) Reactive arthritis
What are the clinical features of a spondyloarthridities?
1) Seronegativity (rheumatoid factor -ve)
2) HLA B27 association
3) ‘Axial arthritis’
4) Asymmetrical large joint oligoarthritis or monoarthritis
5) Enthesis
6) Dactylitis
7) Extra-articular manifestations
What is Ankylosing Spondylitis?
Describe a typical patient?
A chronic inflammatory disease of the spine and sacroiliac joints.
A man <30 years old with gradual onset back pain that is worse at night with spinal morning stiffness that is worsened by exercise.
How does pain radiate in ankylosing spondylitis?
Radiates from the Sacroiliac joints from the hips to the buttocks.
How does a patients mobility change with ankylosing spondylitis?
They eventually get decreased thoracic expansion
Decreased spinal movement/mobility
What investigations should you order for a patient with suspected Ankylosing Spondylitis?
An MRI which will show any inflammatory changes and in later stages of the disease will show an appearance known as “bamboo spine”
Bloods: FBC, CRP, ESR, HLAB27
What is the management for Ankylosing Spondylitis?
Conservative: Exercise not rest
Pharmacological management: NSAID’s can provide relief and slow progression
Consider bisphosphonates
TNF-alpha indicated in severe AS
Surgical intervention: Hip replacement if hips are involved
Spinal osteotomy
What is Enteric Arthropathy associated with?
Inflammatory bowel disease
GI bypass
Coeliac disease
Whipple’s disease
How do you manage Enteric Arthropathy?
Treat the underlying cause.
Use DMARD’s for resistant cases.
What is the incidence of Psoriatic Arthritis?
Occurs in 10-40% with Psoriasis and can present before skin changes.
How does Psoriatic Arthritis present?
- Symmetrical Polyarthritis
- DIP joints affected
- Asymmetrical oligoarthritis
What is the clinical presentation of Reactive arthritis?
“Can’t see, can’t pee, can’t climb a tree”
Conjunctivitis - can’t see
Urethritis - can’t pee
reactive arthritis - can’t climb a tree
Contributes towards Reiter’s syndrome
