MS1: Gout and SLE Flashcards
what is gout
associated w hyperuricemia caused by deposition of monosodium urate crystals or MSU
inflammatory arthritis - group 2
discuss primary gout
due to inherited inborn error ng purine metabolism kaya mag kaka hyperuricemia
discuss secondary gout
from another disease or from the therapy of it
associated w neoplasm, renal disease, diabetes, hyperlipidemia or metabolic disorders
how does hyperuricemia cause gout
excess uric acid in blood forms crystals that collects joint = painful inflammatory response
what are the stages of classic gout
asymptomatic hyperuricemia
acute intermittent gout
advanced gout
discuss asymptomatic hyperuricemia
pag more than 2 standard dev na
female: > 6 mg/dL
male: > 7 mg/dL
so positive bloodwork but wala pa symptoms
when does acute intermittent gout occur
men: 40-60 yo
women: menopause
presentations of acute intermittent gout
sudden warmth, swelling, erythema and pain of joint - 4 cardinal signs
monoarticular tas sa 1st MTP - podagra
systemic symptoms - fever, chills and malaise
other possible joints affected by gout
midfoot, ankle, heel and knee - LE
less common sa UE - wrist, finger and elbow
discuss acute intermittent stage
sa early stages episodes are not as frequent mga years pero evetually it becomes more frequent, longer and more joints
may mga intercritical period
what is intercritical period
period where nawala yung symtoms but may MSU crystals padin sa synovial fluid
when is it considered advanced gout
pag more than 10 yrs na ng acute intermittent gout
discuss advanced gout
aka chronic tophaceous gout - may tophi or parang nodules
associated w:
early onset
untreated gout - 4 attacks per yr
where are subcutaneous tophi commonly found
fingers
wrist
ears
knees olecranon
pressure points
also pwede s kidney, heat and sclerae
discuss the pathogensis of gout
either may overproduction or underexcretion ng MSU
causes of overproduction of MSU
inherited enzyme defect
malignancy, psoriasis and obesity
drugs and food rich in purine
causes of underexcretion of MSU
renal problems, dehydration, salt restriction
hypertension
hyperthyroid or hypo
diabetes
ethanol, diuretics, laxative
SSx of gout
acute monoarticular arthritis - asymmetric
magising from pain and pressure from clothes in masakit
redness and swelling
low grade fever and chills
pwede mag resolve - masama sa blood
90% sa 1st MTP
how to differentiate heberdens from gout
gout is read and whitish tas pag inopen may crystals
other sites of initial gout
instep
ankle
heel
knee
wrist
what makes chronic gout a chronic gout
may tophi sa bone or skin
discuss tophi
higher serum rate = more tophi deposited
typical locations of tophi
ear
elbow
finger
discuss diagnosis process for gout
has swelling, pain or tenderness in joint or bursa > MSU + = gout
paf naman MSU negative proceed to criteria
if wala swelling pain or tenderness or meron pero sa lumbar or shoulder = not gout
discuss gout classification criteria - patter of joint/bursa involvement
0 - other than ankle, midfoot of 1st MTP
1 - ankle or midfoot
2 - MTP1
discuss gout classification criteria - symptomatic episodes
erythema, cant bear touch or difficulty in walking/use joint
0 - none
1 - one
2 - two
3 - three
discuss gout classification criteria - time course of episode
0 - no episodes
1 - one
2 - recurrent
discuss gout classification criteria - tophus
0 - absent
4 - present
discuss gout classification criteria - lab findinfs
basta pag more than 6 mg/dL nag kaka score na
nag nnegative score if negative findings
discuss gout classification criteria - imaging
4 - evidence of urate deposition
4 - gout related damge
discuss imaging for gout
preferred ang CT scan over xray kase di kita sa xray and uric crystals
risk factors of gout
hyperuricemia
alcohol
high meat and seafood intake
CANT LEAP drugs
obesity
hypertension
what is CANT LEAP
drug risk factors for gout
cyclosporine
alcohol
nicotine
thiazides
lasix
ethambutol
aspirin if low dose
pyrazinamide
discuss septic arthritis DD from gout
septic:
no sex predication
group 3 synovial - infectious milky white
high grade fever
antibiotic treatment
knee or shoulder - uncommon ang MTP1
discuss other crystal arthropathies DD from gout
need gram stain and cultures
medications to lower uric acid level
xanthine oxidase inhibitors - allopurinol, febuxostat and uricase
probenecid - inc excretion
high dose aspirin
medications for gout pain
NSAIDS
steroids
colchicine
what is pseudogout
cause by calcium pyrophosphate dihydrate crystals or CPPD
pseudogout is usually associated w ______
trauma, amyloidosis, myxedema, hyperthyroid, gout and hemochromastosis
pathophysio of pseudogout
degenerative and often severe but can be asymptomatic
intermittent attacks of acute
xray shows calcified cartilage
where does pseudogout usually occur in the popu
equal gender tas > 60 yo.
SSx of pseudogout
acute arthritis in larger joints - knee
follows pattern of gout but less severe
may chondrocalcinosis sa xray
trapezoid shaped crystals
identify if gout or pseudogout
middle aged men and postmenopausal women
gout
identify if gout or pseudogout
elderly and equal sex distribution
pseudogout
identify if gout or pseudogout
mono - small joints and LE
gout
identify if gout or pseudogout
mono/poly of UE or LE
pseudogout
identify if gout or pseudogout
acute arthritis is frequent
both
identify if gout or pseudogout
MSU needle shaped
gout
identify if gout or pseudogout
CPP rhomboid shaped
pseudogout
identify if gout or pseudogout
alcohol, trauma, excess meat/fish, medication, stress
gout
identify if gout or pseudogout
stress and trauma
pseudogout
what is calcific tendinitis DD from gout and pseudo gout
hydroxyapatite and crystals tas elderly
SLE is more common in what gender
female
what is SLE
autoimmune attack on multi systems
discuss lab screening for SLE - CBC
look for anemia, leukopenia and throbocytopenia
discuss lab screening for SLE - ESR
can be elevated
discuss lab screening for SLE - urinalysis
proteinuria, hematuria or + casts
discuss lab screening for SLE - ANA and anti-dsDNA/SM
if postive edi may autoimmune/lupus
what are the criteria for SLE
DOPAMIN RASH
discoid rash
oral ulcer
photosensitivity
arthritis
malar rash
immunologic disorder
neurologic disorder
renal disorder
antinuclear antibody
serositis
hematologic
4/11
discuss discoid rash
red raised cricular patches tas pwd mag scar sa older
discuss oral ulcers
oral or nasopharyngeal tas painless
discuss photosensitivity
skin rash due to sunlight
discuss arthritis SLE
affects fingers and wrist but non erosive
discuss malar rash
butterfly rash over nose
discuss neurologic disorder
any - seizures, psychosis mga ganun
discuss renal disorders
most dreaded - persistent proteinuria
discuss antinuclear antibody
+ = SLE
discuss serositis
inflammation
lungs - pneumonia
heart - pericardial effusion
GI - stomach erosion
RA vs SLE cause
RA - autoimmune
SLE - autoimmune
RA vs SLE gender
both female
RA vs SLE symptoms
RA - arthritis is erosive and symmetrical, rashes
SLE - arthritis is non erosive and non symmetrical, rashes is malar or discoid, ulcer
RA vs SLE photosensitivity
meron SLE
RA vs SLE severity
RA - less
SLE - more
non pharmacol treatment of SLE
avoid precipitants, sunblock
cutaneous treatment for SLE
avoid sun, sunblock, topical steroids
MSK treatment for SLE
NSAIDs, predsinone
renal treatment for SLE
Diffuse proliferative glomerulonephritis, high dose steroids, IV cyclophosphamide
cardiopulmo treatment for SLE
NSAID and steroids
hematologic and neurologic treatment for SLE
mga IV eme eme
