MSKS Clinical Lecture 4_Monoarthropathies

Question 1

How is gout diagnosed?

Answer 1

with a polarizing microscope. (will appear as yellow and blue lines when aligned parallel or perpendicular)

Question 2

What is a high uric acid level?

Answer 2

serum uric acid > 6.8mg/dL. Note Hyperuricemia is necessary but not sufficent for a clinical manifestation of gout

Question 3

What are the 4 phases of gout?

Answer 3

• Asymptomatic Hyperuricemia (for several years until 1st attack occurs)
• Acute Gout Attack
• Interval Gout (asymptomatic)-variable time, but most untreated pt’s experience recurrent, acute flares within 2 yrs
• Chronic Gouty Arthritis/Tophaceous Gout-develops within 10-20 years of untreated/undertreated gout

Question 4

What is the first line treatment of accute gout attacks?

Answer 4

NSAIDs followed by Colchicine and then Glucocorticoids

Question 5

What is the first line treatment of chronic gout?

Answer 5

Treatment with Xanthine Oxidase Inhibitors like Allopurinol to decrease uric acid production

Question 6

What are the risck factors for Calcium Pryophosphate Deposition Disease (CPPD)

Answer 6

Age**, hypothyroidism, hyperparathyroidism, hypomagnesemia, hemochromatosis (excessive iron
storage), chronic kidney disease

Question 7

How is CPPD diagnosed?

Answer 7

joint fluid analysis/crystal identification

Question 8

What should cause a high susspecion of CPPD?

Answer 8

pt >65 years with acute/subacute mono-arthritis (esp of knee) and Xray findings of chondrocalcinosis.

Question 9

Fun fact

Answer 9

25-30% of knees replace demonstrate CPPD crystals even though Osteoarthritis was the presumptive diagnosis

Question 10

What knee deformitiy can CPPD cause

Answer 10

new valgus

Question 11

What is first line treatment for accute CPPD?

Answer 11

Intra-articular steroids then Colchicine, and Oral corticosteroids

Question 12

What is first line treatment for chronic CPPD?

Answer 12

Colchicine: 0.6mg BID daily, possibly also use Hydroxychloroquine and methotrexate

Question 13

What are clinical manifestations of septic artheritis

Answer 13

fever, malaise, rapid onset pain with

swelling/warmth and decreased ROM (active AND passive ROM)

Question 14

Does Gonoccal Septic Arthritis have a gender bias?

Answer 14

it is 4 times more likely in women

Question 15

What are the risk factors for septic Arthritis?

Answer 15

Prosthetic knee/hip
History of jointvsurgery
Rheumatoid Arthritis
>80 years of age
Diabetes Mellitus
IV Drug Abuse
STI (for Gonoccal)

Question 16

What is the WBC for non inflamitory, inflamitory, and septic artheropithies?

Answer 16

0-2000: non inflamitory
greater than 2000: inflamitory
greater than 20000: spetic