Painful joints (week 6)

Question 1

what is gout caused by

Answer 1

deposition of monosodium urate monohydrate crystals in/around synovial joints

Question 2

what are the risk factors for gout

Answer 2

alcohol use
high fructose sweetened drinks
high meat and seafood consumption
heart disease, hypertension, diabetes, hyperlipidaemia
renal disease
drugs

Question 3

name for elevated uric acid levels in the blood

Answer 3

hyperuricemia

Question 4

what creates the danger signal for the inflammatory response in gout

Answer 4

uric acid crystals

Question 5

which sex is gout more prevalent in

Answer 5

males (L)

Question 6

what is the main abnormality which causes gout

Answer 6

reduced uric acid excretion by the kidney (genetically determined)

Question 7

typical features of gout

Answer 7

rapid onset (max severity in 2-6 hrs)
severe pain
extreme tenderness - can’t stand anything touching it
swelling with red shiny skin
goes away after 5-14 days

Question 8

what is the inflammation of a joint called

Answer 8

synovitis

Question 9

second attacks? (gout)

Answer 9

often occur within a year and may progress to chronic gout

Question 10

features of chronic gout

Answer 10

chronic pain, joint damage, occasionally severe deformity and functional impairment

Question 11

what do crystals deposited in joints and soft tissues form (gout)

Answer 11

tophi - irregular firm nodules

Question 12

what differentiates nodules in gout to nodules in rheumatoid arthritis

Answer 12

tophi are white

Question 13

gout investigations

Answer 13

identifying urate crystals in aspirate from joint
biochemical screen - hyperuricaemia usually present in gout
X-rays

Question 14

treatment for acute gout

Answer 14

NSAIDs

Question 15

cause of septic arthritis

Answer 15

bacteria in joint

Question 16

what is the most important risk factor for septic arthritis

Answer 16

increasing age

Question 17

risk factors for septic arthritis

Answer 17

age, re-existing joint disease (RA), diabetes, immunosuppression, intravenous drug misuse

Question 18

clinical features of septic arthritis

Answer 18

swollen hot red joint with pain resting and moving. mainly lower limbs.

Question 19

management of septic arthritis

Answer 19

antibiotics - flucloxacillin

Question 20

differences in morning stiffness between OA and RA

Answer 20

OA around 15 mins, RA normally longer

Question 21

identifying sepsis

Answer 21

high/low temperature
tachycardia - high heart rate
tachypnoea - high breathing rate
low blood pressure
hypoxia - low levels of oxygen in tissues
reduced urine output
cold hand and feet
confusion/drowsiness

Question 22

first step when looking at an inflamed joint

Answer 22

aspirate joint (bacteria? crystals?) and send blood cultures

Question 23

what reduces uric acid production and how

Answer 23

allopurinol - inhibits xanthine oxidase

Question 24

what’s the danger signal for RA

Answer 24

altered self-protein - protein isn’t identified as ‘self’

Question 25

coexisting conditions for RA

Answer 25

vascular disease
osteoporosis/fracture
metabolic syndrome
cognitive dysfunction, depression

Question 26

RA diagnosis

Answer 26

multiple joints, symmetrical, symptoms for weeks/months, blood tests

Question 27

RA blood tests?

Answer 27

signs of inflammation.
anti-CCP antibody, rheumatoid factor

Question 28

RA treatment to suppress inflammation?

Answer 28

NSAIDs, corticosteroids

Question 29

RA treatment to suppress immune system

Answer 29

disease modifying anti-rheumatic drugs (DMARD) - methotrexate