Rheumatology Flashcards
What causes gout?
Changes in the metabolism of purine resulting in hyperuricemia, urate crystal deposits in tissues and synovium, resulting in inflammatory arthritis
What test to do if diagnostic uncertainity in gout
Synovial fluid aspiration ?urate crystals
Treatment for acute gout
- High dose NSAID then taper as symptoms improve (avoid in CrCl <40, CHF, PUD)
- Colchicine 0.6mg BID-TID 1-3 d
If NSAID and colchicine contraindicated then use corticosteroids
What is the treatment for urate lowering therapy
Allopurinol 50-100mg OD, increase q 2-4 weeks by 100mg
When to consider prophylactic gout therapy
> / tophi
radiographic evidence of gout
/2 flares per year
What test to do prior to starting allopurinol
HLA-B *5801
What are the risk factors for osteoporosis
- Previous fx after age 40
- Glucocorticoids (>3 months, pred 5mg)
- Falls >/2 past year
- Parent fractured hip
- BMI <20
- Current smoking
- Alcohol >/3 drinks a day
Secondary causes of osteoporosis
Endo - acromegaly, hypercrotisolism, hyperparaT, hyperTSH, hypophosphate
GI - malabsorption, liver dz, calcium deficiency
Medications
How much calcium and vitamin D is recommended
Calcium 1200mg
Vit D 1000IU
Symptoms of polymyalgia rheumatica
Constitutional symptoms
Morning stiffness, symmetrical proximal muscles
What is the inclusion criteria for PMR
Age >50
Duration >2 weeks
Abrupt onset
Morning stiffness >45 min
Bilateral shoulder +/- pelvic pain
High ESR/CRP
What is the exclusion criteria for PMR
Malignancy
Infection
GCA
Inflammatory conditions
Drug induced (statins)
Management of PMR
Prednisone 15-20mg then taper over 2 weeks monitoring ESR
Stomach and bone protection while on steroid
Monitor q3months
- EST, CBC, lytes, glucose
Diagnostic criteria for rheumatoid arthritis
Atleast 4:
- Morning stiffness >/1 hour
- Arthritis >/3 joint areas
- Arthritis of hand joints
- Symmetric
- Rheumatoid nodulews
- Elevated RF
- Radiographic changes
Monitoring for methotrexate
Q4-8 weeks CBC, LFTs, albumin
