Reu 5 - Other Types Of Arthritis

Question 1

What are the causes of high uric acid in the blood?

Answer 1

Increased production of uric acid (eating purine rich foods), lower excretion of uric acid (thiazide or loop diuretic), Lesc-Nyhan syndrome, or going thru leukemia/lymphoma (increased cell turn over).

Question 2

What is the clinical presentation of gout?

Answer 2

Asymmetric joint inflammation, monoarticular.

Question 3

What can trigger acute gout attacks?

Answer 3

Large meals, alcohol consumption (alcohol metabolites compete for the same excretion site as uric acid).

Question 4

What is the treatment for acute gout flare?

Answer 4

Colchicine (stabilizing tubulin to inhibit polymerization, impairing leukocyte chemotaxis). Causes diarrhea And almost no one uses it anymore. NSAIDs (indomethacin [classic]). Real world uses a short round of steroids.

Question 5

What is the long term treatment for gout?

Answer 5

Increases renal excretion of uric acid (Probenecid- inhibits reabsorption of uric acid in the PCT). Reduce uric acid synthesis (Allopurinol, Febuxostat- inhibits xanthine oxidase, which is responsible for converting xanthine to uric acid).

Question 6

What crystal accumulates in pseudogout?

Answer 6

Calcium pyrophosphate crystals.

Question 7

What are the symptoms of pseudogout?

Answer 7

Large joints, typically the knee. Affects older patients. Causes chondrocalcinosis, seen in X-ray of large joints.

Question 8

What are the characteristics of seronegative spondyloarthropathies?

Answer 8

Arthritis (especially in the spine), rheumatoid factor is NEGATIVE, strong association with HLA-B27.

Question 9

What are the disease associated with HLA-B27?

Answer 9

[PAIR]

Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease spondylitis, Reactive arthritis.

Question 10

What is Psoriatic arthritis?

Answer 10

Inflammatory arthritis associated with psoriasis. Often asymmetric, affects the fingers (DIP joints, x-ray may show bony erosions “pencil and cup deformity”), spine and sacroiliac joints.

Question 11

What is Ankylosing Spondylitis?

Answer 11

Chronic inflammatory disease of the spine and the sacroilleitis. This can lead to fusion of the SI joints or between the discs (bamboo spine), causing reduced spine mobility but improves with exercise.

Question 12

What disease are associated with Ankylosing Spondylitis?

Answer 12

Uveitis, aortic regurgitation, conduction abnormalities, CV disease.

Question 13

What is Reactive arthritis?

Answer 13

Arthritis that typically comes on after certain infections (Chlamydia or GI infections -Shigella, Salmonella, Yersinia, Campylobacter, Clostridium).

Question 14

What is the classic triad of reactive arthritis?

Answer 14

[Can’t pee, can’t see, can’t climb a tree]

AKA Reiter syndrome, it is conjunctivitis (or uveitis), Urethritis, arthritis.

Question 15

What do TNF-alpha does? What do TNF-alpha inhibitors do?

Answer 15

TNF-alpha: Cytokine that induces the immune system. TNF-alpha inhibitor are drugs that bind to TNF-alpha, prevent it from activating the immune system.

Question 16

What are five TNF-alpha inhibitors?

Answer 16

Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab.

Question 17

What do we have to watch out for with the use of TNF-alpha inhibitors?

Answer 17

It increases the risk of infection, especially the reactivation of TB. PPD skin test must be carried out before using this drug.

Question 18

What is Juvenile Idiopathic Arthritis (JIA)?

Answer 18

Affects children (onset before age 10), causes persistent joint swelling (synovial thickening, accumulation of synovial fluid).

Question 19

What are the three subtypes of Juvenile Idiopathic Arthritis?

Answer 19

Polyarticular JIA (severe symmetrical arthritis; dactylitis), Pauciarticular JIA (typically involves large joints; joint 20-25% have uveitis), Systemic-onset JIA (AKA Still’s disease, begins with systemic symptoms-rash, fever, elevated WBC, anemia, hepatosplenomegaly, lymphadenopathy, arthritis later.

Question 20

What are the three main organisms that cause septic arthritis?

Answer 20

Staph aureus, streptococcus, Neisseria gonorrhoeae.

Question 21

What are the presentations of Gonococcal arthritis?

Answer 21

Polyarticular, migratory arthritis, has an asymmetric pattern.

Question 22

What is the treatment for septic arthritis?

Answer 22

IV antibiotics, consult orthopedic surgeon to clear all that pus in the joint.

Question 23

RFF: Swollen, red, acutely painful great toe joint.

Answer 23

Gout.

Question 24

RFF: Positive birefringent rhomboid-shaped crystals.

Answer 24

Pseudogout.

Question 25

RFF: Negative birefringent needle-shaped crystals.

Answer 25

Gout.

Question 26

RFF: Bamboo spine on x-ray.

Answer 26

Ankylosing spondylitis.

Question 27

RFF: HLA-B27.

Answer 27

Seronegative spondyloarthropathies.

Question 28

Why do we not start with allopurinol during an acute gout attack?

Answer 28

Changes in uric acid levels may worsen or prolong an acute attack.

Question 29

What is the cause of gout?

Answer 29

High levels of uric acid in the blood. Then it precipitates out as crystals of monosodium urate in the joints. These crystals trigger inflammatory response and pain.