(Nisha) Rheumatology p189-204 Flashcards
Chronic, slowly progressive, erosive damage to joint surfaces; loss of articular cartilage causing increasing pain with minimal or absent inflammation
Osteoarthritis
Increasing ____ and ____ to the joint increases incidence of DJD
Age, trauma
Does playing contact sports and obesity increase DJD?
Yes
What joints is DJD present in?
Weight bearing joints (knee, hip, ankle)
What joints are affected in osteoarthritis?
DIP> PIP and MCP
Heberden nodes
DIP enlargement
Bouchard nodes
PIP enlargement
Are lab tasts normal or abnormal in Osteoarthritis?
Normal
The most accurate test for osteoarthritis
Radiography of the affected joint
What will X-ray of affected joint show? (osteoarthritis)
Joint space narrowing, osteophytes, dense subchondral bone, bone cysts
How do you treat osteoarthritis?
Weight loss & moderate exercise Acetominophen (best initial analgesic) NSAIDS Capsaicin cream Intraarticular steroids (if other medical therapy does not control the pain) Hyaluronan injection in joint Joint replacement if disease is severe
Absence of inflammation, normal lab tests, short duration of stiffness distinguishes _____ from _____
DJD, rheumatoid arthritis
Defect in urate metabolism with 90% of cases in men. (urate overproduction or underexcretion)
Gout
Causes of overproduction of urate?
Idiopathic
Increased turnover of cells (cancer, hemolysis, psoriasis, chemotherapy)
Enzyme deficiency (Lesch-Nyhan syndrome, glycogen storage disease)
Causes of under excretion of urate?
Renal insufficiency
Ketoacidosis or lactic acidosis
thiazides and aspirin
A 58 year old man comes in with fever and sudden excruciating pain, redness, and tenderness of the big toe at night after binge drinking. Dx?
Gout
MTP joint of the great toe is the most frequently affected site in gout. True or false?
True. Can also occur in the ankle, feet, knees
Presentation of chronic gout?
Tophi tissue (deposition of urate crystals)
Uric acid kidney stones
Long asymptomatic period between attacks
What is the most accurate test for Gout?
Aspiration of the joint showing needle shaped crystals with negative birefringence on polarized light microscopy
Treatment of Acute attack (Gout)
NSAIDS > colchicine - best initial therapy
Corticosteroids (steroids is the answer when no response to nsaids or contraindications to nsaids such as renal insufficiency)
Colchicine used in those who cannot use either NSAIDS or steroids
Treatment of Chronic Gout?
Diet (decrease alcohol, high purine foods such as meat and seafood)
Stop thiazides, aspirin, and naicin (use losartan first for HTN)
Colchicine (effective at preventing second attack of gout and sudden fluctations in uric acid levels due to probenecid or allopurinol)
Pegloticase (dissolves uric acid)
Probenecid and sulfinpyrazone (increase excretion of uric acid) - rarely used
Side effect of colchicine ?
Diarrhea, bone marrow suppression (neutropenia)
TEN and Steven johnson syndrome is a side effect of what drug used for gout?
Allopurinol
Best drug for BP in gout?
Losartan (ARB) lowers uric acid
Calcium containing salt depositing on articular cartilage ?
Pseudogout (CPDD)
Risk factors for pseudogout?
Hemachromatosis, hyperparathyroidism, diabetes, hypothyroidism, wilson disease
What joints are affected in Pseudogout?
large joints. knee, wrist
Are DIP and PIP affected in CPDD?
No
Most accurate test for CPDD?
Arthrocentesis (positively birefringement rhomboid shaped crystals)
CPPD treatment?
NSAIDS. severe disease (intraarticular steroids such as triamcinolone), colchicine prevents subsequent attacks
a 80 year female comes in with painful joints (DIP, PIP, hip and knees). The pain worsens with use. Aspiration of synovial fluid shows <200 wbc, osteophytes and joint space narrowing. Dx?
Osteoarthritis
A 40 year old man comes in with pain of the big toe after a night of binge drinking. Aspiration shows 2k-50k WBC, negatively birefringent needles. Dx?
Gout
A 40 year old man with hx of hemochromatosis and hyperparathyroidism comes in with pain in his wrists and knees. Aspiration shows 2k - 50k WBC, positively birefringent rhomboids and chrondrocalcinosis on x-ray. Dx?
CPDD
a 25 year old female comes to the clinic complaining of pain in the joints of her hands. She says the pain is severe in the morning and gets better with use. Aspiration shows 10k-20k wbc, antiCCP. Dx?
R.A
A 18 year old male comes to clinic complaing of a hot knee joint. He has a fever of 102F. Aspiration shows >50k neutrophils. Dx?
Septic arthritis
Lumbosacral strain treatment?
Nsaids
Compression of the spinal cord is due to ?
malignancy, infection.
