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Y4 MSK > Rheum week 1 - hot, painful, swollen joint > Flashcards

Rheum week 1 - hot, painful, swollen joint Flashcards

1
Q

Give 4 possible causes of a hot swollen joint …

A
  • septic arthritis always consider as most inportant
  • gout / pseudogout
  • reactive arthritis
  • psoriatic arthritis
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2
Q

What do tophi look like ?

A

little growths - almost like keloids on the ear

like white balls under the skin on finger pads

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3
Q

What nail changes do you expect to see in psoriatic arthritis ?

A
  • nail pitting (like needle pinpricks all over)
  • oncholysis (areas where the nail has lifted from the nail bed - looks the same as the whit email off the end of finger just in the middle/connected to white)
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4
Q

What are tophi indicative of ?

A

gout

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5
Q

What are some risks factors for gout ?

A
  • male
  • overweight
  • high alcohol intake
  • high purine intake (e.g steak, oily fish, marmite, beans)
  • diuretics
  • metabolic syndromes (diabetes, HTN)
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6
Q

What is the gold standard investigation to help diagnose gout ?

A

joint aspiration and synovial fluid analysis

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7
Q

What investigations need to be done if gout is suspected ?

A
  • joint aspiration and analysis

others:
- FBC rule out septic
- blood cultures rule out septic
- U+Es and LFTs influence meds
- CRP and ESR inflammatory markers, monitor treatment response

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8
Q

When should rheumatoid factor and CCP antibody testing be done?

A

if RA is a differential diagnosis

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9
Q

can XR be used to diagnose/assess acute gout?

A

no!

  • XR may show damage due to chronic gout
  • XR is useful in cases of pseudo gout
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10
Q

What is the treatment of gout ?

A
  • patient education
  • rest, elevate and cool affected joint
  • NSAIDs at highest dose e.g naproxen (consider PPI for gastric protection)
  • oral colchicine
  • ## steroid injection can use IV or oral steroids if injection isn’t appropriate
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11
Q

which medication is best for treating symptoms of acute gout?

A

NSAIDs (e.g naproxen) or colchicine

NSAIDs - highest dose available
Colchicine - 500 micrograms BD

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12
Q

When is Colchicine prescribed to treat gout?

A

in acute cases, where patients cannot be prescribed NSAIDs

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13
Q

What drug treatment is offered to patients who experience recurrent episodes of gout to prevent future attacks ?

A

urate-lowering therapy (ULT)
allopurinol

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14
Q

When can you start allopurinol to prevent future gout attacks ?

A

at least 2 weeks after acute gout has settled otherwise it can flare the gout back up

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15
Q

What drug can you give to prevent future gout attacks that also act to decrease tophi?

A

allopurinol

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16
Q

What is a common side effect of colchicine?

A

diarrhoea

17
Q

What can trigger gout?

A
  • purine high diet
  • alcohol
  • diuretic use
  • injury
  • dehydration
  • inflammation
  • haemolytic anaemias
  • blood cancers
  • renal failure
18
Q

What can trigger gout?

A
  • purine high diet
  • alcohol
  • diuretic use
  • injury
  • dehydration
  • inflammation
  • haemolytic anaemias
  • blood cancers
  • renal failure
19
Q

What drug is used as urate-lowering therapy in patients who cannot take allopurinol ?

A

febuxostat

20
Q

Describe gout to a patient …

A
  • gout is caused by a build up of uric acid in a joint.
  • uric acid comes from breakdown of a compound called purine which is found in most foods.
  • usually the kidneys get rid of most of the uric acid in urine, but some gets cycled back to the body.
  • therefore a build up of uric acid is caused by either taking in too much purine (food) or not getting rid of enough (kidneys)
21
Q

Does another gout attack while on allopurinol and naproxen/colchicine mean that the treatment isn’t working ?

A

no!
it is relatively common for patients to experience attacks do gout up to 12 months after starting treatment

22
Q

What changes would you see on XR in established gout ?

A

juxta-articular erosions

23
Q

What is the most appropriate initial treatment of gout?

A

Naproxen and a PPI

or straight to colchicine if patient can’t take NSAIDs or has tried ibuprofen and doesn’t feel it’s working

24
Q

How does allopurinol work ?

A

takes uric acid from soft tissue and into blood for excretion via kidneys

25
Q

How does a second attack of gout occur even when on allopurinol ?

A
  • allopurinol moves uric acid from tissues to blood
  • once blood is saturated uric acid can move back into joints and cause another flare up
26
Q

How long should a patient be on combined allopurinol and colchicine for ?

A

six months in order for the colchicine to avoid allopurinol-induced attacks

27
Q

When can allopurinol be stopped to cure a patient of gout ?

A

never !
it’s a lifelong drug

Y4 MSK (11 decks)

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