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Rheumatoid > Non-Systemic Inflammatory Rheumatic Disorders > Flashcards

Non-Systemic Inflammatory Rheumatic Disorders Flashcards

1
Q

Condition where monosodium urate (MSU) crystals deposit in soft tissues
or joints (less vascular tissue) (Cartilage, tendons, joints -Smaller joints)

A

Gout

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2
Q

When gout happens in the great toe, it is called

A

Podagra

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3
Q

What is the most common cause of inflammatory arthritis in men >40 years old?

A

Gout

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4
Q

Which joints are primarily affected by gout?

A

Joints involved – usually the cold joints

MTP, forefoot, ankle, knee, wrist, fingers

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5
Q

Primary Gout Categories

A

Overproducers – 10% (HPRT deficient)

Underexcretors- 90%

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6
Q

Secondary Gout Causes

A

Excess nucleoprotein turnover (Lymphoma, Leukemia)

Increased cell proliferation/death (Psoriasis)

Rare genetic disorder (Lesch-Nyan Syndrome)

Pharmaceuticals (diuretics)

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7
Q

Four Phases of Gout

A
  1. Asymptomatic hyperuricemia
  2. Acute gouty arthritis
  3. Intercritical gout
  4. chronic tophaceous gout
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8
Q

List some causes of Gout

A

Hyperuricemia (Patients can also have a high level without gout)

High alcohol consumption (Especially beer)

High high-fructose corn syrup diet

Medications (Diuretics – thiazide and loop diuretics, ASA, niacin)

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9
Q

Hyperuricemia level in women

A

Females >6 mg/dL

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10
Q

Hyperuricemia level in men

A

Male > 7mg/dL

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11
Q

Common medications that can precipitate gout

A

Diuretics – thiazide and loop diuretics

ASA

niacin

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12
Q

What are some other conditions/signs to consider gout diagnosis/workup?

A

Renal lithiasis

Uric acid nephropathy

Urate nephropathy

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13
Q

What is the definitive diagnosis of gout?

A

Synovial joint fluid analysis –> MSU crystals in synovial fluid (needle-like, Negative birefringence)

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14
Q

On join fluid analysis you see crystals that are needle-like with negative birefringence, this is a diagnosis of what?

A

Gout

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15
Q

X-ray finding in Gout

A

Punched out lesions (“rat bit sign”, erosion)

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16
Q

If you see a “rat bite sign” on an X-ray, what should you suspect?

A

Gout

17
Q

Which foods should be decreased/eliminated (Low purine diet) post gout?

A

Decrease EtOH
organ meats
red meats
sardines
high fructose corn syrup

18
Q

What are the two most common drugs used in acute gout?

A

NSAIDs (Indocin)
Cochicine

19
Q

What is the DOC for chronic tophaceous gout?

A

Allopurinol

20
Q

What condition is described below?

Usually commences symptomatically 1-8 weeks after exposure to the drug –
symptom complex can be severe

Classic combination: rash, fever, and major internal organ involvement (most
commonly hepatitis, but also can be nephritis and pneumonitis)

A

Allopurinol Hypersensitivity Syndrome

21
Q

What is the most common type of patient you can see Allopurinol Hypersensitivity Syndrome?

A

Southeast Asian ancestry

22
Q

What is the marked risk factor for severe allopurinol cutaneous reaction?

A

HLA-B*5891

23
Q

What demographic of patients are likely to see HLA-B*5891?

A

Koreans with CKD, and those of Han Chinese and Thai descent

24
Q

What are the features of DRESS? (Drug Reaction with Eosinophilia and Systemic Symptoms)

A

Cutaneous rash

Fever

Renal dysfunction

Hepatitis

Leukocytosis

Death

25
Q

What does DRESS stand for?

A

Drug Reaction with Eosinophilia and Systemic Symptoms

26
Q

What is pseudogout?

A

Calcium pyrophosphate deposition disease

27
Q

Calcium pyrophosphate deposition disease is also known as?

A

“pseudogout”

28
Q

CCPD presents like:

A

Gout

Pseudo-RA

Pseduo-OA

Pseudo-ankylosing spondylitis (disk calcification, decreased spinal mobility)

Pseudo-neuropathic arthritis (resorptive disease)

29
Q

Pseudogout commonly presents in which joint(s)?

A

Most commonly presents in the knee

Prefers the larger joints (knee, wrist, etc)

30
Q

What condition is described below?

Crystals can deposit in cartilage (chondrocalcinosis), synovial cavity,
or synovium (chronic)

A

Pseudogout

31
Q

What are some associated conditions with pseudogout?

A

Hyperparathyroidism

Hypercalcemia

Hypocalciuria

Hemochromatosis

Hypothyroidism

Gout

Osteoarthritis (Goes hand in hand with OA – every time see CPPD, the patient also has OA going on)

Aging (50% in 80s)

32
Q

What is the definitive diagnosis of pseudogout?

A

Analysis of synovial fluid:

CPPD crystals – blunted, rhomboid/prism (or rod) shaped

Weakly positive birefringence

Light blue when parallel

33
Q

On join fluid analysis you see crystals that are blunted, rhomboid/prism (or rod) shaped with weakly positive birefringence, this is a diagnosis of what?

A

Pseudogout

34
Q

An Xray that shows an appearance of punctate and linear
densities in articular hyaline or fibrocartilaginous tissue should raise your suspicion for what diagnosis/condition?

A

Pseudogout

35
Q

How is pseudogout treated?

A

Joint aspiration

Injection with steroids

NSAIDs

There is no medication to reduce the amount of CPPD crystals in your
system

Rheumatoid (6 decks)

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