rheum Flashcards
what does CREST syndrome stand for?
Calcinosis Raynaulds esophageal dysmotility (can present with dysphasia) sclerodactyly telangiectasia
if a patient has known rheumatoid arthritis and develops increased SOB and on CT shows ground glass appearance of the lung and linear reticular opacities
interstitial lungs disease and switch off of methotrexate to avoid further deterioration of the lung function
If you take an aspiration of a joint what would the presence of crystals tell you?
whether it is gout or pseudo gout
to tell the difference between both of these you are going to see shape and birefringent
gout- rod shaped and neg birefringent
pseudo- ca pyrophosphate pos birefringent and rhomboid shapes.
you take a joint aspiration what are the sings of infection?
cloudy with high WCC, high NEUT, and bacteria visiable on micro and pos blood culture is septic arthritis
NB high WBC in crystal arthropathies
false negative rate of 20-25% of gonococcal septic arthritis
If you find blood and fat in the aspirate of the joint what is that indicative of
fracture
if just blood means trauma plus or minus fracture
elevated WBC in the joint aspirate in the absence of crystals, blood and infection
reactive arthritis (Reiter’s syndrome) enteric arthropathy (IBD) rheumatoid arthritis, psoriatic art, and rheumatic fever
If there is non-inflammatory aspirate in the joint
suggests trauma or osteoarthritis
What auto anti-body screen would you order?
Rheum- rheumatoid factor, anticyclic citrullinated peptide (anti CCP), antinuclear antibodies (ANA)
What routine bloods would you order?
FBC - infection
C RP
ESR
what joint aspiration result is pathognomic from acute gout?
neg birefringent crystals with increased WBCC predominantly polymorphonuclear cells.
What is the acute treatment for gout?
colchicine administered within 24 hours (CI in hepatic and renal imp)
NSIADs= CI in peptic ulcer disease or acute or chronic renal failure heart failure or preg
corticosteriod injection
Chronic management of gout
decrease urate production: allopurinol and febuxostat inh xanthine oxidase and limit the production of uric acid
NB cholchicine must always be co prescribed for the first 6 weeks.
increased urate excretion: sufinpyrazone and probenecid inhibit the reuptake of urate at the proximal convulsed tubules
increase degradation of urate: rasburicase is a uric ase enzyme (chemo patients)
What is the classical symptoms of reiter’s syndrome?
can’t see, can’t pee, can’t climb a tree
uveitis urethritis and arthritis
why might urate be elevated?
primary (90)
enzyme defects
secondary (10)
increased nuclei acid turnover (leuk, polycythemia, chemo)
decreased excretion due to renal failure or thiazides
What is the common infective organism in a native joint
staph aureus
immunosuppressive mycobacterium tuberculosis
STI N. gonorrhoea
sickle cell: salmonella
