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Medical conditions > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are monosodium urate crystals?

A

Crystals formed from uric acid deposition in joints and tissues.

> Triggers the inflammatory response characteristic of gout.

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2
Q

Typical timing of onset of a gout attack.

A

Sudden onset of severe joint pain, often waking patient at night

Redness, warmth, swelling, and tenderness over the affected joint

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3
Q

What is the typical demographic affected by gout?

A

Typically occurs in middle-aged to elderly individuals, more common in men than women with a ratio of approximately 3:1.

Unhealthy, purine-rich diet.

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4
Q

What are some factors leading to reduced urate excretion? List at least 3.

A
  • Renal impairment
  • Use of diuretics
  • Hypertension
  • Lead exposure
  • Endocrine disorders
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5
Q

What factors can lead to excessive urate production?

Include dietary and other conditions

A
  • High dietary intake of purines
  • Sugary foods and drinks
  • Excessive alcohol consumption
  • Obesity
  • Certain medications
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6
Q

True or False: Gout can occur in individuals with normal uric acid levels.

A

True

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7
Q

What are the key components of acute gout management?

A
  • NSAIDs - particularly naproxen
  • Colchicine
  • Oral corticosteroids (if colchicine is contraindicated)
  • IL-1 inhibitors
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8
Q

Fill in the blank: Gout crystals are _______ shaped and are negatively birefringent.

A

needle

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9
Q

What is the first-line urate-lowering therapy for chronic gout?

A

Allopurinol

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10
Q

What complications can arise from untreated gout?

A
  • Chronic joint damage
  • Tophi formation
  • Kidney stones/kidney damage
  • Cardiovascular disease
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11
Q

What lifestyle modifications are recommended for gout management?

A
  • Dietary changes
  • Reducing alcohol intake
  • Increasing hydration
  • Weight loss
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12
Q

What is a typical patient presentation for gout?

A

A middle-aged male experiencing sudden, intense pain in the big toe, red, swollen, and tender joint, often triggered by dietary excesses or dehydration.

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13
Q

What imaging modalities can detect urate crystals in joints?

A
  • Ultrasound
  • Dual-Energy CT Scanning
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14
Q

Differentiate between gout and pseudogout crystals.

Describe the type and apperance of crystals

A

Gout is caused by monosodium urate crystals; pseudogout is caused by calcium pyrophosphate deposition, presenting with positively birefringent rhomboid-shaped crystals.

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15
Q

What is the mechanism of colchicine in gout management?

A

Inhibits microtubule formation, reducing neutrophil migration and inflammatory response.

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16
Q

What is a common side effect of colchicine?

A

Diarrhoea

17
Q

What can trigger an acute gout attack when starting urate-lowering therapy?

A

Initial fluctuations in uric acid levels causing existing urate crystals to mobilise.

18
Q

What is rheumatoid arthritis (RA)?

A

A chronic, systemic autoimmune disease characterized by inflammation of the synovial joints, leading to joint destruction, pain, swelling, and reduced movement.

RA can also have extra-articular manifestations and significantly affect quality of life.

19
Q

What is synovitis in the context of RA?
Which two cytokines are commonly involved?

A

An immune-mediated attack on the synovium, resulting in inflammation and destruction of articular cartilage and bone.

Key immune cells and cytokines involved include TNF-alpha and IL-6.

20
Q

What is the distribution of arhtritis in rheumatoid arthritis?

A

Multiple and symmetrical.

Morning stiffness > 30 mins

Other symptoms:
* Fatigue
* Malaise
* Weight loss
* Myalgia
* Low-grade fever

21
Q

What are some extra-articular complications of RA? Which common disease should be monitored and prevented?

A
  • Reynaud’s phenomenon
  • Skin rash
  • Ocular conditions (e.g., keratoconjunctivitis sicca)
  • Pulmonary involvement (e.g., pleural effusion)
  • Anaemia of chronic disease
  • Cardiovascular risks
  • Neurological complications
  • Felty’s syndrome (RA, neutropenia and splenomegaly
  • Vasculitis
  • Secondary Sjögren’s syndrome
  • Cervical myelopathy

These complications can significantly affect patient health beyond joint issues.

22
Q

What are common examination findings in RA?

A
  • Rheumatoid nodules
  • Deformities (in advanced cases)
  • Swelling, tenderness, and warmth in affected joints
  • Reduced range of motion

Rheumatoid nodules are firm, non-tender subcutaneous nodules over bony prominences.

23
Q

What laboratory tests are used to diagnose rheumatoid arthritis?

A
  • Rheumatoid factor (RF)
  • Anti-cyclic citrullinated peptide (anti-CCP) antibodies
  • Elevated ESR and CRP levels

RF is present in 60-70% of RA patients; anti-CCP is present in 80%.

24
Q

What imaging findings are associated with rheumatoid arthritis?

A
  • Soft tissue swelling
  • Periarticular osteopenia
  • Bone erosion/deformities
  • Narrowed joint spaces

Advanced cases may show fused wrist bones.

25
Q

What is the first-line pharmacological treatment for RA?

A

Disease-modifying antirheumatic drugs (DMARDs), primarily methotrexate.

Other DMARDs include sulfasalazine, leflunomide, and hydroxychloroquine.

Management of RA invovles medication, rehab, lifestyle changes, psychosocial support.

26
Q

Fill in the blank: Methotrexate works by inhibiting _______ to reduce immune cell proliferation.

A

dihydrofolate reductase

This action helps slow disease progression and minimize joint damage.

27
Q

What are some side effects of Methotrexate?

A

It is typically administered weekly, with folic acid supplementation to reduce side effects.

  • gastro-intestinal toxicity (stomatitis, diarrhoea),
  • pulmonary toxicity,
  • liver toxicity,

Methotrexate is contraindicated in active infection. Could usually restart 1 week after antibiotics are taken.

28
Q

What scoring system is used to monitor activity of rheumatoid arthritis?

A

A Disease Activity Score (DAS) is a composite score that measures how active rheumatoid arthritis (RA) is in a patient.

DAS-28 for 28 joints.

Used monthly until full control of disease. Combination of factors.

29
Q

What is the threshold for switching to biologics treatment? E.g. An infusion

A

Failure to manage rheumatoid arthritis after 2 DMARDs, including methotrexate.

30
Q

What if infliximab?

A
  • IV Rituximab (B cell, CD20)
  • IV Infliximab (anti-TNF alpha)
  • SC adalimumab (anti-TNF alpha)

These are all biologic treatments for RA

Medical conditions (25 decks)

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