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MSK > Rheumatology and crystalline arthritis > Flashcards

Rheumatology and crystalline arthritis Flashcards

1
Q

List characteristics of inflammatory arthritis

A

Morning stiffness > 30 minutes
Swelling, warmth
Pain improves with activity
Distribution- mostly small joints

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2
Q

List characteristics of non-inflammatory pain

A

Morning stiffness <30 minutes
No swelling/ warmth
Pain worsens with activity
Distribution- mostly large weight bearing joints

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3
Q

Acute monoarthritis is considered _____ until proven otherwise

A

infectious

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4
Q

Synovial fluid from non-inflammatory arthritis is usually ______ in color and cellularity is ______

A

straw clear, viscous, <1500 cells

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5
Q

Synovial fluid in inflammatory arthritis is ____ in color, cellularity is _______

A

cloudy and thin, 1000-100K cells

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6
Q

Synovial fluid in septic arthritis is ____ and cellularity is _____

A

purulent, 80-100K cells

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7
Q

List radiographic features of gout

A

soft tissue swelling, erosions, tophi with punched out “bites” and overhanging edges

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8
Q

List radigraphic features of CPPA/ pseudogout

A

articular or meniscal cartilage calcification, degenerative changes

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9
Q

MOst hyperuricemic patients are _______

A

underexcretors (not inborn error of metabolism)

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10
Q

List factors that can decrease urinary excretion of uric acid

A 
alcohol
chronic kidney disease
diuretics, low dose aspirin, cyclosporine
obesity
high protein diet
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11
Q

List symptoms of gout

A

pain, swelling, warmth, redness, tenderness in joints

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12
Q

What is the joint most commonly affected by gout?

A

Great toe- podagra
midfoot- very specific
ankle, knee

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13
Q

In most patients, acute gout will resolve within ______ with or without treatment

A

3-7 days

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14
Q

Where to tophi most commonly occur?

A

fingers, wrists, ears, knees, olecranon, pressure points, Achilles tendons

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15
Q

What is the preferred therapy for acute gout

A

Colchicine within 48 hours

can also try indomethacin, corticosteroids

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16
Q

What is the mechanism of colchicine?

A

arrest of microtubule assembly, inhibits cellular inflammation, IL-1 activation, neutrophil adhesion

17
Q

List indications for chronic uric acid lowering therapy

A
  1. gout with recurrent attacks (>3 in 1 year or 5 lifetime episodes)
  2. extreme hyperuricemia (~ >13)
  3. tophus/tophi or erosive gout changes on radiograph
  4. uric acid nephropathy, or uric acid nephrocalculi
  5. as prophylaxis before cytolytic treatment to prevent tumor lysis syndrome.
18
Q

What drugs can be used for chronic gout therapy?

A

Allopurinol (+ colchicine for the first 6 months)
Febuxostat
Uricosurics- probenecid, sulfinpyrazole, high dose aspirin

19
Q

What is the mechanism of action of allopurinol?

A

potent inhibitor of xanthine oxidase so decreases uric acid production

20
Q

What are indications for allopurinol?

A

maintenance agent to lower uric acid levels to treat : recurrent, tophaceous, or erosive gout or for patients with uric acid nephrolithiasis

21
Q

Introducing allopurinol during an acute gout flare can:

A

worsen the flare- start 2 weeks after resolution

22
Q

______ is overlapped with allopurinol for the first 6 months to prevent new flares

A

Colchicine

23
Q

What are side effects of allopurinol?

A

cytopenia, rash, drug fever, hypersensitivity, SJS

24
Q

It is important to never re-challenge after allopurinol hypersensitivity because of risk of _____

A

SJS

25
Q

Some _____ populations may get genetic testing to reduce the risk of allopurinol hypersensitivity

A

Asian

HLA-B5801 allele

26
Q

What is the mechanism of action of febuxostat

A

non-purine selective inhibitor of xanthine oxidase

27
Q

What is the indication for febuxostat?

A

chronic gout treatment in the setting of allopurinol hypersensitivity

28
Q

What is the general mechanism of “urcosurics”

A

Increase uric acid excretion

29
Q

List examples of urcosurics

A

probenecid, sulfinpyrazone, high dose aspirin

30
Q

Acute CPPA develops when _____ crystals are released from cartilage and phagocytosed by neutrophils, initiating joint pain and swelling

A

calcium phyrophosphate

31
Q

What is the major radiographic finding of CPPA?

A

chondrocalcinosis

32
Q

What joints are most often affected by CPPA?

A

knee, wrists, ankles, shoulders

may present as hastened osteoarthritis

33
Q

Unlike gout, ____ is NOT a precipitating factor for CPPA

A

alcohol

34
Q

List medical conditions associated with CPPA

A

hypothyroidism, hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypophosphatemia,

MSK (25 decks)

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