Rheumatology Flashcards
Acute management of gout - first line
NSAIDs (max dose for 102 days after symptoms settle + PPI) or Colchicine
Allopurinol started 2 weeks after attack
Acute on chronic gout - pt is on allopurinol next step
continue allopurinol
How to initiate allopurinol treatment
- 2 weeks after acute attack
- titrate every few weeks to aim serum uric acid <260 (<300 if severe)
- lower initial dose for low eGFR
- Cholchicine/NSAID cover when starting (up to 6mo)
Alternative medical ways to reduce uricaemia in gout (chronic)
- ?stop thiazide
- consider losartan if HTN
- incr vit C (diet/supplements)
Main fts of temporal arteritis
- > 60yrs
- rapid onset (<1mo) unilateral headache
- jaw claudication
- tender,palpable temporal artery
- amauroxis fugax/diplopia
- fts of PMR (prox limb stiffness)
- letargy/low-grade fever, anorexia, night sweats
Investigations findings for temporal arteritis
- raised ESR/CRP
- CK normal
- EMG normal
- definitive = temporal artery biopsy - skip lesions
Tx of temporal arteritis
URGENT
- high dose glucocorticoid if suspected
- ophthalmology review
What glucocoirticoid given in temporal arteritis
- no visual loss = high dose prednisolone
- evolving visual loss = IV methylprednisolone first
polymyalgia rheumatica fts
- > 60yrs
- rapid onset (<1mo)
- aching morning stiffness in prox limbs (not weakness)
- lethargy/low-grade fever/anorexia/night sweats
Investigation findings in polymyalgia rheumatica
- raised ESR/CRP
- CK normal
- EMG normal
Treatment polymyalgia rheumatica
predisolone 15mg OD
(dramatic response)
Sx of osteomalacia
- bone pain
- bone/muscle tenderness
- fractures (NOF)
- proximal myopathy (waddling gait)
Investigation findings in osteomalcia (bloods and xray)
- low vit D
- low Ca + PO4
- raised ALP
- xray = translucent bands (Looser’s zones/pseudo fractures
Medical Mx Osteomalacia
- Vit D supp (loading dose initially)
- Ca supp if dietary Ca inadequate
Pathogenesis of ostemolacia
softening of bones 2ry to low vit D level –> low bone mineral content
