Non-Systemic Inflammatory Rheumatic Disorders Flashcards
Condition where monosodium urate (MSU) crystals deposit in soft tissues
or joints (less vascular tissue) (Cartilage, tendons, joints -Smaller joints)
Gout
When gout happens in the great toe, it is called
Podagra
What is the most common cause of inflammatory arthritis in men >40 years old?
Gout
Which joints are primarily affected by gout?
Joints involved – usually the cold joints
MTP, forefoot, ankle, knee, wrist, fingers
Primary Gout Categories
Overproducers – 10% (HPRT deficient)
Underexcretors- 90%
Secondary Gout Causes
Excess nucleoprotein turnover (Lymphoma, Leukemia)
Increased cell proliferation/death (Psoriasis)
Rare genetic disorder (Lesch-Nyan Syndrome)
Pharmaceuticals (diuretics)
Four Phases of Gout
- Asymptomatic hyperuricemia
- Acute gouty arthritis
- Intercritical gout
- chronic tophaceous gout
List some causes of Gout
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)
Hyperuricemia level in women
Females >6 mg/dL
Hyperuricemia level in men
Male > 7mg/dL
Common medications that can precipitate gout
Diuretics – thiazide and loop diuretics
ASA
niacin
What are some other conditions/signs to consider gout diagnosis/workup?
Renal lithiasis
Uric acid nephropathy
Urate nephropathy
What is the definitive diagnosis of gout?
Synovial joint fluid analysis –> MSU crystals in synovial fluid (needle-like, Negative birefringence)
On join fluid analysis you see crystals that are needle-like with negative birefringence, this is a diagnosis of what?
Gout
X-ray finding in Gout
Punched out lesions (“rat bit sign”, erosion)
If you see a “rat bite sign” on an X-ray, what should you suspect?
Gout
Which foods should be decreased/eliminated (Low purine diet) post gout?
Decrease EtOH
organ meats
red meats
sardines
high fructose corn syrup
What are the two most common drugs used in acute gout?
NSAIDs (Indocin)
Cochicine
What is the DOC for chronic tophaceous gout?
Allopurinol
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)
Allopurinol Hypersensitivity Syndrome
What is the most common type of patient you can see Allopurinol Hypersensitivity Syndrome?
Southeast Asian ancestry
What is the marked risk factor for severe allopurinol cutaneous reaction?
HLA-B*5891
What demographic of patients are likely to see HLA-B*5891?
Koreans with CKD, and those of Han Chinese and Thai descent
What are the features of DRESS? (Drug Reaction with Eosinophilia and Systemic Symptoms)
Cutaneous rash
Fever
Renal dysfunction
Hepatitis
Leukocytosis
Death
What does DRESS stand for?
Drug Reaction with Eosinophilia and Systemic Symptoms
What is pseudogout?
Calcium pyrophosphate deposition disease
Calcium pyrophosphate deposition disease is also known as?
“pseudogout”
CCPD presents like:
Gout
Pseudo-RA
Pseduo-OA
Pseudo-ankylosing spondylitis (disk calcification, decreased spinal mobility)
Pseudo-neuropathic arthritis (resorptive disease)
Pseudogout commonly presents in which joint(s)?
Most commonly presents in the knee
Prefers the larger joints (knee, wrist, etc)
What condition is described below?
Crystals can deposit in cartilage (chondrocalcinosis), synovial cavity,
or synovium (chronic)
Pseudogout
What are some associated conditions with pseudogout?
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)
What is the definitive diagnosis of pseudogout?
Analysis of synovial fluid:
CPPD crystals – blunted, rhomboid/prism (or rod) shaped
Weakly positive birefringence
Light blue when parallel
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?
Pseudogout
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?
Pseudogout
How is pseudogout treated?
Joint aspiration
Injection with steroids
NSAIDs
There is no medication to reduce the amount of CPPD crystals in your
system
