Rheumatology and crystalline arthritis Flashcards
List characteristics of inflammatory arthritis
Morning stiffness > 30 minutes
Swelling, warmth
Pain improves with activity
Distribution- mostly small joints
List characteristics of non-inflammatory pain
Morning stiffness <30 minutes
No swelling/ warmth
Pain worsens with activity
Distribution- mostly large weight bearing joints
Acute monoarthritis is considered _____ until proven otherwise
infectious
Synovial fluid from non-inflammatory arthritis is usually ______ in color and cellularity is ______
straw clear, viscous, <1500 cells
Synovial fluid in inflammatory arthritis is ____ in color, cellularity is _______
cloudy and thin, 1000-100K cells
Synovial fluid in septic arthritis is ____ and cellularity is _____
purulent, 80-100K cells
List radiographic features of gout
soft tissue swelling, erosions, tophi with punched out “bites” and overhanging edges
List radigraphic features of CPPA/ pseudogout
articular or meniscal cartilage calcification, degenerative changes
MOst hyperuricemic patients are _______
underexcretors (not inborn error of metabolism)
List factors that can decrease urinary excretion of uric acid
alcohol chronic kidney disease diuretics, low dose aspirin, cyclosporine obesity high protein diet
List symptoms of gout
pain, swelling, warmth, redness, tenderness in joints
What is the joint most commonly affected by gout?
Great toe- podagra
midfoot- very specific
ankle, knee
In most patients, acute gout will resolve within ______ with or without treatment
3-7 days
Where to tophi most commonly occur?
fingers, wrists, ears, knees, olecranon, pressure points, Achilles tendons
What is the preferred therapy for acute gout
Colchicine within 48 hours
can also try indomethacin, corticosteroids
What is the mechanism of colchicine?
arrest of microtubule assembly, inhibits cellular inflammation, IL-1 activation, neutrophil adhesion
List indications for chronic uric acid lowering therapy
- gout with recurrent attacks (>3 in 1 year or 5 lifetime episodes)
- extreme hyperuricemia (~ >13)
- tophus/tophi or erosive gout changes on radiograph
- uric acid nephropathy, or uric acid nephrocalculi
- as prophylaxis before cytolytic treatment to prevent tumor lysis syndrome.
What drugs can be used for chronic gout therapy?
Allopurinol (+ colchicine for the first 6 months)
Febuxostat
Uricosurics- probenecid, sulfinpyrazole, high dose aspirin
What is the mechanism of action of allopurinol?
potent inhibitor of xanthine oxidase so decreases uric acid production
What are indications for allopurinol?
maintenance agent to lower uric acid levels to treat : recurrent, tophaceous, or erosive gout or for patients with uric acid nephrolithiasis
Introducing allopurinol during an acute gout flare can:
worsen the flare- start 2 weeks after resolution
______ is overlapped with allopurinol for the first 6 months to prevent new flares
Colchicine
What are side effects of allopurinol?
cytopenia, rash, drug fever, hypersensitivity, SJS
It is important to never re-challenge after allopurinol hypersensitivity because of risk of _____
SJS
