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Clinical Physiology > Scleroderma and Gout > Flashcards

Scleroderma and Gout Flashcards

1
Q

Reynauds + autoimmune condition presents with

A

ulcers on the fingers
can progress to osteomyelitis (infects bone)

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2
Q

skin tightness causes

A

difficulty eating
difficulty maintaining dental hygiene
breathing difficult when skin tight

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3
Q

tests for Reynauds associated with autoimmune?

A

use a microscope to look at nail beds (capilloroscopy)
will see dilation of vessels

thermal thresholds

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4
Q

limited vs diffuse scleroderma

A

limited - limited to trunk and upper areas of limbs
diffuse - all skin

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5
Q

scleroderma

A

Systemic autoimmune disease, largely auto-antibody mediated The disease is characterized by progressive thickening and fibrosis of the skin (secondary to excessive collagen deposition). There is often a degree of fibrosis of internal organs.

Vascular dysfunction (reynauds) and abnormalities can precede the skin changes/organ involvement by years

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6
Q

scleroderma

A

Systemic autoimmune disease, largely auto-antibody mediated The disease is characterized by progressive thickening and fibrosis of the skin (secondary to excessive collagen deposition). There is often a degree of fibrosis of internal organs.

Vascular dysfunction (reynauds) and abnormalities can precede the skin changes/organ involvement by years

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7
Q

most common affected system by scleroderma

A

gastric - reflux

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8
Q

systems affected by scleroderma

A

gastrointestinal
pulmonary
cardiac
MSK
renal

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9
Q

involvement of GI with scleroderma

A

Esophageal dysmotility Small bowel bacterial overgrowth
Gastric antral vascular ectasia

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10
Q

involvement of pulmonary with scleroderma

A

Fibrosis Pulmonary arterial hypertension

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11
Q

involvement of cardiac with scleroderma

A

Scleroderma heart

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12
Q

involvement of MSK with scleroderma

A

Inflammatory joints
Calcinosis
Telangiectasia
Raynaud’s with digital ulceration
Myositis

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13
Q

involvement of renal with scleroderma

A

renal crisis

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14
Q

primary vs secondary reynauds

A

primary - reynaud’s only not associated with ulcers/autoimmune
all symmetrically involved fingers

secondary - reynauds caused by autoimmune e,g, scleroderma, lupus, dermatomyositis

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15
Q

pathophysiology of scleroderma

A

connective tissue consists of ECM, inc fibroblasts
in scleroderma fibroblasts hyperactive - deposits of fibrous tissue

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16
Q

treatment for myositis

A

steroids

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17
Q

complications of scleroderma

A

renal crisis

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18
Q

microangiopathy

A

pathology of small blood vessels

19
Q

schistocytes

A

present in MAHA (microangiopathic hemolytic anaemia)

20
Q

very high BP + headaches

A

suggestive of end organ failure

21
Q

benefits of ACE inhibitor

A

BP but also good to control seizures and in renal failure

22
Q

What BP tablet should not be used in patients with Reynaud’s?

A

beta blockers (e.g., labetalol)
especially non selective beta blockers/beta 2

23
Q

hypertensive crisis presentation

A

CNS - headache, swelling in brain
cardiac - acute MI, pulmonary oedema
renal - acute kidney failure
ocular - blood vessels burst/swell leading to blindness

24
Q

what can predict phenotype of disease in scleroderma?

A

antibodies

25
Q

conservative management of reynauds

A

Avoid triggers: stop b-blockers
Stop smoking
Gloves

26
Q

pharmacological management of reynauds

A

CCB - nifedipine
SSRI - fluoextine
sildenafil - pulmonary hypertension

27
Q

management in patients with digital ulceration

A

bosentan
iloprost

28
Q

surgical management of reynauds

A

sympathectomy

29
Q

can scleroderma be cured?

A

no, treat symptoms

30
Q

management of GI scleroderma symptoms

A

High dose PPI
Antibiotics: metronidazole, ciprofloxacin, rifaximin
Endoscopic ablation

31
Q

management of pulmonary scleroderma symptoms

A

fibrosis - Mycophenolate
Rituximab
Cyclophosphamide
Nintendanib

pulmonary hypertension - Sildenafil, Taladafil Epoprostenol Bosentan/ Ambtisentan

32
Q

management of renal crisis

A

ace inhibitor

33
Q

gout

A

associated with uric acid crystal deposition into the joints

34
Q

DD for an acutely swollen joint

A

septic arthritis
gout

35
Q

diagnosis of gout

A

aspirate the joint and look with polarised light

36
Q

risk factors for gout

A

high alcohol intake
purine rich meats and seafood

37
Q

why does purine increase gout risk?

A

purine eventually forms urate if this isn’t excreted properly it will deposit in joint

38
Q

pathophysiology of gout

A

inflammation response to deposition of monosodium urate crystals in joint

high levels of uric acid from:
- under excretion of urate from kidneys
- under excretion of urate from GI
- over production of urate

39
Q

acute treatments for gout

A

NSAID’s - don’t use in cardio risk patients/gi bleeding
colchicine
steroids
anakinra - only in very severe gout in repetitive attacks

40
Q

long term treatment for gout

A

after acute treatment, urate lowering therapy

41
Q

side effects of allopurionol

A

High fever
Hematological abnormalities
Inflammation of one or more internal organs
Characteristic rash
Lymphadenopathy

42
Q

what increases risk of DRESS

A

HLA-B*58:01 allele

43
Q

gout increases risk of _____

A

high BP
high triglycerides
coronary artery disease

Clinical Physiology (11 decks)

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