RHEUM 1 Flashcards
gout in who
increased urate production
decreased urate excretion
M>W. uncommon before menopause
inherited enzyme defects, severe psoriasis, haemolytic disorders, alcohol, high dietary purine intake
chronic renal impairment, volume depletion (HF), hypothyroidism, diuretics, lead toxicity
acute symptoms of gout
chronic tophyeous gout
gouty trophi
abrupt onset and usually overnight. painful hot swollen joint. first MTP usually, wrist, ankle, knee, settles in 7-10 days without treatment, may have normal uric acid during acute attack
chronic joint inflammation. often diuretic associated with increased uric acid
white accumulations of uric acid erupt through skin, may get acute attacks, can result in destructive erosive arthritis
ix for gout
treatment for acute
treatment for chronic
increased uric acid not in acute. increased inflam markers. renal impairment. XR. needle shaped negatitive birefringace
NSAIDs. Colchamine (diarrhoea). PO pred
analgesia. continue allopurinol during acute if already on it
allopurinol.
febuxostat
start 2 w after acute attack and cover w NSAIDs
pseuodogout in who where risk factors ix treatment
elderly. related to OA. affects fibrocartilage
larger joints and pain is mod compared to gout.
knees wrists shoulder ankles
hyperparathyroidism, hypothyroidism, haemachromatosis, acromegaly, decreased Mg, decreased phosphate, wilsons
XR shows chondrocalcinosis
calcium phosphate crystal s- rhomboid, smaller than urate crystals, weakly pos
NSAIDs. colchamine.
steroids. rehydration
hydroxyapatite also called what
what is it
who
treatment
milwaukee shoulder
hydroxyapatite crystal deposition in/around joint. release of collagen eases serum proteases and IL1
acute rapid deterioration. F>M. 50-60s
NSAIDs. intra articular steroid injection. physio. partial or total arthroplasty
takaya A is what in who symptoms assoc with ix treatment
inflammation, arteritis obliterative affecting aorta and branches
F>M, asians, young
malaise headache. occlusion of aorta - absent limp pulses. unequal BP in upper arms. carotid bruit. intermittent claudication in upper limbs. aortic regurgitation in 20%
RAS
ESR affected during acute phases
steroids
giant cell arteritis what
in who
ix
treatment
large and medium vessels. TA commonest type.
F>M. >50s
ESR PV CRP increase. MRI angiography. PECT. temp artery biopsy - granulomatous lesions - skip lessons
pred. metho/azithro
kawasaki disease in who symptoms ix and dx treatment complication
predom children
high grade fever lasting over 5 days which is resistant to antipyrexials. conjunctival injection. bright red cracked lips. strawberry tongue. cervical LD. red palms and red soles of feet which later peel
clinical dx. ECHO - coronary artery aneurysm
high dose aspirin. IV immunoglobulins.
coronary artery aneurysm
polyarteritis nodusa is what
associations and in who
symptoms
ix
systemic necrotising vasculitis affecting medium vessels leading to aneurysm
Hep B. middle aged men. renal disease in 70%. ANCA pos in 20%
fever malaise arthralgia weight loss htn. mono neuritis multiplex. sensory/motor polyneuropathy. testicular pain. lived reticularis. haematuria. renal failure.
angiography - sacular or fusiform aneurysms and arterial stenosis
EGPA is what symptoms what can precipitate it ix treatment
small medium vessel disease late onset asthma. high eosinophil count >10%. paranasal sinusitis. mononeuritis multiplex. rhinitis. LKRA ANCA. pANCA in 60% IV steroids and cyclophosphamide
GPA is what and where and in who symptoms ix treatment medial survival
small and medium vessels
upper and lower respiratory tract and kidneys. M>F. 35-55
epistaxis, sinusitis, nasal crusting, deafness, mouth ulcers, OME, haemoptysis, SOB, cough, pulmonary infiltrates, diffuse alveolar haemorrhage, palpable purpura, RPGN, CN palsies, proptosis, conjunctivitis. saddle shaped nose
CANCA >90%. PR3. CXR - caveatting nodules. Renal biopsy - epithelial crescents in BC
IV steroids, cyclophosphamide, plasma exchange
8-9y
microscopic polyangitis is what
symptoms
ix
cx
small vessel disease
renal impairment. fever. lethargy. myalgia, decreased weight, palpable purpura. cough, SOB. haemoptysis. mono neuritis multiplex
ANCA
GN in 90% of px
HSP is what degree of overlap with what what does it affect and in who symptoms ix treatment
small vessel. acute IgA mediated disorder
Bergers disease (IgA neuropathy) small vessel - skin, GIT, kidneys, joints, CNS children 2-11
<75% have had URTI, pharyngeal infection, GI infection, purpuric rash over buttocks and extensor surfaces or arms and legs, abd pain, vomit. 50% have renal impairment
urinalysis to screen for renal impairment
supportive self limiting within 8 weeks. 1/3 relapse
