SBAs: Rheumatology Flashcards
Why does gout so often present in the big toe?
Last place blood reaches from aorta, poor venous return, uric acid able to accumulate
Describe the symptoms of gout
Erosive arthritis: warm, swollen, tender and very painful
Recall a sign of gout away from the monoarthropathy
Tophi (lumps of uric acid) in ears and on elbows
What is the dietary component that causes gout in excess, and in what sort of foods is it found?
Purines: port, red wine, cheese
Recall 3 causes of gout
- Purine-rich diet
- Kidney failure
- Leukaemia/ lymphoma
How does leukaemia lead to gout?
Tumour lysis syndrome
Very high levels of urate released following chemotherapy
What urate level is diagnostic of gout?
> 450
Describe the shape of the crystals in gout
Negative birefringent needle-shaped crystals
How can you examine crystal shape in gout?
Do a needle biopsy
Describe the shape of the crystals in pseudogout
Positive birefringent rhomboid-shaped crystals
What tests must be done when gout is suspected?
Needle biopsy
X ray of joint
What is the management of acute gout, and what must you be particularly careful about?
NSAIDs and steroids
Cannot give NSAIDs to renal failure patients
What is the management of chronic gout?
Allopurinol
What is the mechanism of action of allopurinol?
Xanthine oxidase inhibitor
How can patients with tumour lysis syndrome be protected from gout?
Giving prophylacted IV rasburicase: it is a recombinant urate oxidase
What sort of nodes do you see in osteoarthritis?
Heberden’s (distal)
Bouchard’s (proximal)
Recall the mnemonic for and the X ray features of osteoarthritis
LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts
When is rheumatoid arthritis pain worst?
Morning
Which joints are most commonly affected by rheumatoid arthritis?
MCP and PIP
Recall 3 features of rheumatoid arthritis on the hands
Swan-necking
Boutoniere
Ulnar deviation
Which is the most specific immunoglobulin to rheumatoid arthritis?
Anti-CCP
What score is used to grade the severity of rheumatoid arthritis?
DAS28
Recall the medical management of rheumatoid arthritis
DMARDs
Recall an example of a DMARD drug
Methotrexate