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Finals Revision Flashcards > MSK and Rheum - Gout, Pseudogout, Fibromyalgia > Flashcards

MSK and Rheum - Gout, Pseudogout, Fibromyalgia Flashcards

1
Q

Gout - what is it?

A

Gout is a form of arthritis caused by the deposition of monosodium urate crystals in and around the joints, causing them to be hot, swollen and painful

Caused by the precipitation of uric acid crystals within the joint leading to an acute inflammatory response

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2
Q

Gout - what are the causes?

A 
Causes of Gout= DART
D- iuretics
A- lcohol
R- enal disease
T- rauma

MEDICATIONS - thiazide diuretics and aspirin

Increased CONSUMPTION of purines - shellfish, red meat, anchovies

Decreased clearance of uric acid - dehydration, excessive alcohol consumption

CKD - unable to excrete uric acid

Obesity and diabetes

Chemo and radiotherapy - increases cell break down

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3
Q

Gout - how does it normally present?

A

Presents with arthritis of the 1st MTP (metatarsophalangeal) joint

Characterised by sudden, severe attacks of pain, swelling, redness and tenderness

Often base of the big toe joint

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4
Q

Gout - what are the non-modifiable risk factors?

A

Age >50 years

Family history

Male

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5
Q

Gout - what are the clinical features and does it present symmetrically or asymmetrically?

A

Presents asymmetrically

  1. Excruciating, sudden, burning pain in the affected joint
  2. Swelling, redness, warmth, and stiffness in the affected joint
  3. Mild fever
  4. Tachycardia - transient sympathetic response to pain of an acute attack
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6
Q

Gout - how do you diagnose and what do you need to exclude?

A

Need to exclude septic arthritis

  1. Arthrocentesis with synovial fluid analysis.
    - needle-shaped monosodium urate crystals with negative birefringence confirm gout and differentiate it from pseudogout
    - fluid sent for gram stain and culture to rule out septic arthritis
  2. XRAY
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7
Q

Gout - what would you find on XRAY?

A

NORMAL JOINT SPACE

Lytic lesions in the bone

Punched out erosions - have sclerotic borders with overhanging edges

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8
Q

Gout - what is Gouty tophi?

A

Gouty tophi - subcutaneous deposits of uric acid affecting small joints and connective tissues of hands, elbows and ears

DIP joints in hands most affected

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9
Q

Gout - what measurement is chronic hyperuricaemia defined as?

A

Chronic hyperuricaemia: uric acid > 450 µmol/l

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10
Q

Gout - what is the acute attack management?

A

1st line: NSAIDs (Indomethacin) and Colchicine

  • If both contraindicated, use oral prednisolone 15mg/day
  • if patient already on allopurinol, continue it

Even though NSAIDs is 1st line, CAN’T GIVE ASPIRIN, as aspirin is a cause of Gout

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11
Q

Gout - which NSAID can you not give 1st line in acute attack gout?

A

Even though NSAIDs is 1st line, CAN’T GIVE ASPIRIN, as aspirin is a cause of gout

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12
Q

Gout - what is the main side-effect of colchicine?

A

Diarrhoea

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13
Q

Gout - what is the urate lowering therapy (prophylaxis)?

A

1st line: ALLOPURINOL, xanthine oxidase inhibitor, initial dose of 100 mg od

Serum uric acid aim of < 300 µmol/l

Don’t start allopurinol until 2 weeks after an acute attack, starting too early may precipitate a further attack

2nd line: FEBUXOSTAT, xanthine oxidase inhibitor, given if allopurinol CI

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14
Q

Gout - what are the lifestyle changes a patient can do?

A

Reduction of alcohol consumption

Reduction of purine-based foods- meat and seafood

Medications that may cause hyperuricaemia reviewed: Thiazides and loop diuretics, Low dose salicylates, Chemotherapy

Staying hydrated

Losing weight

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15
Q

Pseudogout - what is it?

A

A crystal arthropathy caused by deposition of calcium pyrophosphate crystals in the synovium

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16
Q

Pseudogout - what are the main risk factors?

A

Increasing age is a big risk factor

If a patient develops gout under the age of 60, they usually have:

  1. haemochromatosis
  2. hyperparathyroidism
  3. low magnesium, low phosphate
  4. acromegaly
  5. Wilson’s disease
17
Q

Pseudogout - what joints are most commonly affected?

A

knee, wrist and shoulders

18
Q

Pseudogout - what is the clinical presentation and features?

A

Inflammation and pain in one joint, hot, swollen, stiff, painful knee - usually monoarticular arthritis but may be oligoarticular

Can be asymptomatic

Affected joints are acutely inflamed with swelling, effusion, warmth and tenderness

19
Q

Pseudogout - what is the definitive diagnosis and what do you need to exclude?

A

Need to exclude septic arthritis

Joint aspirated for synovial fluid

Aspirated fluid will show:

  1. No bacterial growth
  2. Calcium pyrophosphate crystals
  3. Rhomboid shaped crystals
  4. Weakly Positive birefringent of polarised light (Positive, P, Pseudogout P)
20
Q

Pseudogout - what is the pathognomonic finding on XRAY

A

CHONDROCALCINOSIS - appears as a thin white line in the middle of the joint space caused by the calcium deposition

Pathognomonic (diagnostic) of pseudogout

21
Q

Pseudogout - management?

A

Symptoms usually resolve spontaneously over several weeks

Symptomatic management involves (as for gout):

  1. NSAIDs
  2. If NSAIDs contraindicated, then Colchicine
  3. If both contraindicated, then oral steroids, or intra-articular injection
22
Q

What are the shape and characteristics of crystals for gout, pseudogout, osteoarthritis and RA?

A

Gout- monosodium urate crystals that are needle-shaped that are negatively birefringent under polarised light

Pseudogout- calcium pyrophosphate crystals are rhombic/brick shaped that are positively birefringent under polarised light

Osteoarthritis- calcium phosphate crystals associated with degeneration of cartilage, coffin-lid shaped with no birefringence

Rheumatoid arthritis- cholesterol crystals, these are rhombic/brick-shaped with a negative birefringence

23
Q

Fibromyalgia - what is it?

A

Syndrome characterised by WIDESPREAD PAIN throughout body at specific anatomical sites

24
Q

Fibromyalgia - who does it affect more and at what age?

A

Affects women more than men

30-50yo

25
Q

Fibromyalgia - what are the clinical features?

A
  1. Chronic pain
  2. Cognitive impairment - ‘fibro fog’
  3. Headaches and dizziness
  4. Lethargy
26
Q

Fibromyalgia - investigations?

A

Clinical diagnosis

American College of Rheumatology classification criteria:

  1. 9 pairs of tender points
  2. If >11/18 = fibromyalgia more likely
27
Q

Fibromyalgia - management?

A
  1. Explanation
  2. Aerobic exercise
  3. CBT
  4. Medications - pregabalin, amitriptyline, duloxetine

Finals Revision Flashcards (49 decks)

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