Rheum #4 Flashcards
how many people with radiographic OA have symptoms?
33%
Common S&S of OA
joint pain w/ motion, relieved with rest
short duration of stiffness (<30 min) after immobility (GELLING)
what are herberdens and bouchards nodes
herberden- distal nodes
bouchards- pip
common back OA locations
l4/l5, l5/s1
C5 and c6
radiographic hallmarks of OA
loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
non pharm tx of OA
- pt education
- weight loss
- Exercise + physiology
- Acu around jt
meds for OA?
acetaminophen up to 4 g/d
NSAIDs (2nd line)
3rd line (acetaminophen and codein)
4th line (cortciosteroid or hyaluronic acid)
what is gout + who does it affect
defect in urate metabolism with 90% of cases in men
-forms monosodium urate crystals
major risk factors of gout
Diet (alcohol, red meats and seafoods)
Diuretics
major S&S of gout
1) acute gouty arthritis (pain, redness, joint swelling, usually lower extremities)
2) Tophi (urate deposites, commonly first MTP)
3) Kidney –> uric acid nephrolithiasis
common locations of gout
1st mtp = podagra
ankle
knee
2 precipitants of gout, acronyms
FACT (furosemide, aspirine/alcohol, cylclosporine, thiazide diuretics)
SALT (seafood, alcohol, liver/kidney, turkey (meat) )
Best investigations for gout
joint aspirate (negatively birefringent, needle-shaped) 2. (normal in early disease, cortical erosion happens later)
is elevated uric acid level alone good enough for indication for treatment for gout?
no, you must tap the joint
best initial treatment for acute gout
NSAIDs
treatment for chronic gout?
conservcative –> decrease high-purine foods (meat + seafood), alcohol and beer
avoid drugs with hyperuricemic effects (thiazide)
what is pseudogout also known as
Calcium Pyrophosphate Dyhidrate Disease (CPPD)
Caused by calcium pyrophosphate crystals
slower onset than gout (pt will not wake up w severe pain)
S&S of pseudogout (CPPD)
asymptomatic cyrstal deposition, with acute crystal arthritis that resembles gout
may cause psuedo-OA, but does not affect DIP and PIP
What areas does pseudogout ignore
DIP and PIP
common sites of gout/CPPD
knee (MC), polyarticular wrist, hand (mcp only), foot (1st mtp), hip
most accurate test for pseudogout?
joint aspiration
how to differentiate gout vs pseudogout on aspiration
on aspiration, crystals are positive birefringence (blue) and rhomboid shaped in pseudogout/cppd
treatment for pseudogout
NSAIDs (best)
intraarticular or oral steroids for inflammation
characteristics of polymyalgia rheumatica (PMR)
pain and stiffness at proximal extremities (girdle)
no muscle weakness
2:1 F/M
normally over age 50
S&S of Polymyalgia rheumatica (PMR)
constitutional symptoms (fever, weight loss, malaise)
pain and stiffness at proximal muscles
difficult combing hair, rising from chair
tender muscles but NO TRUE WEAKNESS OR ATROPHY
Investigations for polymyalgia rheumatica (PMR)
elevated ESR and CRP U/S and MRI thyroid profile electrolytes level FBS rheumatic factor (RF)
required diagnostic criteria for polymyalgia rheumatica (PMR) because it is dx of exlcuison (3)
age > 50 yr
bilateral shoulder aching (no weakness tho)
abnormal ESR/CRP (elevated)
PMR morning stiffness?
lasts for hours!
treatment for PMR
prednisone 10-20mg orally will help with pain, should be continued for 1-2 yrs
the most frequent vasculitis in north america is?
giant cell arteritis (large vessel vasculitis)
S&S of giant cell Arteritis
new onset temporal headache
sudden, painless loss of vision and/or diplopia
tongue and jaw claudication
PMR present in 30% of cases
Investigations for Giant Cell Arteritis
Increased ESR
Increased CRP
Temporal artery biopsy (most accurate)
Giant Cell Arteritis diagnositic crtieria (how many do u need)
1.Age at onset 50
2.New headache (Often temporal)
3.Temporal artery abnormality (temporal artery tenderness or decreased pulsations, not due to arteriosclerosis)
4.Elevated ESR (ESR ≥ 50 mm/hr.)
5.Abnormal artery biopsy (Mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells)
●
GCA is Diagnosed if 3 or more of the above 5 criteria present
if suspect GCA, treatment?
immediate high dose prednisone, may need methylprednisolone IV
this is an emergency!
prognosis related to giant cell arteritis
increased risk of thoracic aortic aneurysm and aortic dissection
investigations for Fibromyalgia
TSH and ESR (typically normal)
order laboratory sleep assessment
Diagnostic criteria for fibro
widespread pain index over 7 and Symptom Severity over 5
OR
WPI 3-6 and SS scale over 9
treatmetns for fibro
education, exercise, stress reduction,
low dose tricyclic antidepressent. NSAIDS NOT first line
etiology of chronic fatigue syndrome
More sprevelent in women
Suggested causes in chronic fatigue syndrome
- exposure to toxins etc
- genetic abnormalities
- immune response to inf
- microbial inf
- trauma
