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Medical Junior > Management of RA, OA, SLE, Gout > Flashcards

Management of RA, OA, SLE, Gout Flashcards

1
Q

Criteria for clinical diagnosis of gout

A
  1. Hx at least 2 attacks of painful joint swelling
  2. Hx of podagra at 1st MTP
  3. Presence of tophi
  4. Rapid response to colchicine
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2
Q

Characteristics of gouty tophi

A
  1. Firm
  2. Nodular/ Fusiform swelling
  3. Painless
  4. Subcutaneous
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3
Q

Investigation to confirm gout (Gold Standard)

A
  1. Serum uric acid
    - male & post menopausal women > 7mg/dL
    - pre menopausal women > 6mg/dL
  2. Joint aspiration
    - presence of monosodium urate crystal
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4
Q

Investigation to look for associated condition to gout

A
  1. FBC - TRO infection
  2. Serum Urea/Creatinie - TRO renal dz causing hyperuricemia
  3. Blood Glucose - Assess for DM
  4. UFEME - Blood & protein (renal dz)
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5
Q

MSU crystal vs CPPD crystal shape

A

MSU - Slender needles & rods
CPPD - Small, rhomboid

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6
Q

Findings of acute & chronic gout on xray

A

Acute - Soft tissue swelling

Chronic
- Tophi
- Punched out articular bone lesion
- Preserved joint space

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7
Q

Acute gout flare management principles

A
  1. Pill in the pocket - Colchicine, NSAIDs, Steroids
  2. Choice of drug - depend on pt
  3. Adjunctive - drink lots of water
  4. Urate lowering therapy - Allopurinol
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8
Q

Guideline for Gout Management

A

2020 ACR Guideline for Gout Management

Indication to Initiate ULT (Allopurinol):
1. 1/more subcutaneous tophi
2. Radiographic damage
3. Frequent gout flares, > 2 years

  • Avoid ULT in first presentation of gout
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9
Q

Uric acid lowering strategies

A
  1. Inhibit uric acid production - Allopurinol
  2. Promote uric acid excretion - Probenecid
  3. Convert uric acid to allantoin
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10
Q

Severe cutaneous adverse reaction (SCAR) of Allopurinol & alternative management

A
  1. Toxic Epidermal Necrolysis (TENs)
  2. Steven JOhnson SYndrome (SJS)
  3. Allopurinol Hypersensitivity Syndrome (AHS)
  • change allopurinol to febuxostat
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11
Q

Possible colchicine side effect

A
  • diarrhea
  • nausea & vomiting
  • marrow suppression
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12
Q

What is asymptomatic hyperuricemia, do we treat it with allopurinol?

A

Asymptomatic hyperuricemia
- High uric acid, without gout attacks

X start allopurinol
- harm outweughs benefit

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13
Q

Serum uric acid target for acute & chronic gout

A

Acute: SUA < 360 umol/L
Chronic: SUA < 300 umol/L

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14
Q

Risk factor of RA

A
  1. Increasing age
  2. Female
  3. First degree relative
  4. Smoking
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15
Q

Characteristics of RA bone

A
  1. Pannus
  2. Synovial hyperplasia
  3. Cartilage damage
  4. Bone matrix destruction
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16
Q

Imprtant test for RA in physical examination & finding

A

Squeeze test (at MCP & MTP)
- tenderness

17
Q

Common deformity in RA

A
  1. Fusiform swelling (PIP)
  2. Boutonniere deformity - weak central slip of EET
  3. Swan neck deformity - flexor contraction
  4. Ulnar deviation - subluxation of MCPJ
  5. Z deformity
  6. Piano key ulnar head
  7. Claw toe
18
Q

Xray finding of RA (ABCDES)

A

Alignment
Bones - Juxta-articular osteopenia
Cartilage - uniform loss of joint space
Deformities
Erosions - Margina
Soft tissue swelling

19
Q

Non pharmacological treatment of RA

A
  1. Lifestyle changes - stop smoking
  2. Physiotheraphy
20
Q

Pharmacological treatment of RA

A

First line: DMARDs
Second line: Biologic DMARDs / Targeted DMARDs
Add on: NSAIDs for pain, corticosteroids (prednisolone)

21
Q

4 types of DMARDs (Disease Modifying Anti Rheumatic Drugs)

A
  1. Conventional DMARDs
  2. Targeted synthetic DMARDs
  3. Biologic DMARDs
  4. Biosimilar DMARDs
22
Q

4 commonly used conventional DMARDs

A
  1. Methotrexate
  2. Sulfasalazine
  3. Hydroxychloroquine
  4. Leflunomide
23
Q

Side effect of Methotrexate & prophylaxis

A

Folic acid reduction: Ulcers in mouth, Low HB

Prophylaxis: Folic acid 5mg /week

24
Q

What is PsA

A
  • Chronic, progressive, inflammatory disorder of joint & skin
  • Characterized by osteolysis & bony proliferation
25
Clinical patterns of PsA
1. Dactylitis - sausage digits - Cardinal feature 2. Enthesitis - Cardinal feature 3. Assymetric oligoarthritis 4. Symmetric polyarthritis 4. Spondylitis 5. DIP arthritis 6. Nail abnormalities - highly likely to have PsA from PsO 7. Arthritis Mutilans
26
Transitional phase from PsO to PsA
1. Psoriasis 2. Preclinical PsA - Aberrant immune activation phase 3. Subclinical PsA - Silent inflammatory phase 4. Prodromal PsA - Transitional phase 5. PsA
27
Psoriatic arthritis symptoms
PSA 1. Pain 2. Stiffness, Swelling 3. Axial involvement
28
Treatment of PsA
DMARDs (similar to RA)

Medical Junior (29 decks)

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