SLE and Gout Flashcards
Systemic Lupus Erythromatosus?
- Disease with clinical features and autoantibodies directed against various components of the cell nuclei
- An inflammatory disease caused when the immune system attacks its own tissues
- Lupus can attack the joints, skin, kidneys, blood cells, brain, heart and lungs
- Incidence 40/100,000 with 80% being female
Criteria for SLE diagnosis?
4 out of SOAP BRAIN MD
SOAP criteria?
Serositis – pleuritis, pericarditis
Oral ulcers – or nasal ulcers seen by a clinician
Arthritis – non-erosive, symmetrical – hands, knees, wrists
Photosensitivity – skin rash caused by unusual sun reaction
BRAIN criteria?
Blood (hematologic) – hemolytic anemia, leucopenia, lymphopenia, thrombocytopenia
Renal – proteinuria, RBCs, and WBC casts
Anti-nuclear-antibody (ANA)
Immunologic – anti-DNA or anti-smith antibodies
Neurologic – seizures, psychosis
MD criteria?
Malar rash- fixed erythema over the nose and cheeks
Discoid rash – red, raised, scaling plaques that scar
Other clinical features of SLE?
- Fatigue
- Fever
- Weight loss
- Myalgias
- Urticaria
- Non-specific rashes
- Peripheral neuropathy
Investigations of SLE?
- FBC
- ESR
- CRP
- Renal Function Tests
- ANA
- C3 and C4
- Xray
Xray findings in SLE?
- Soft tissue swelling
- Juxta-articular osteopenia
- Avascular Necrosis
- Reducible subluxations
- But NO erosions
Treatment of SLE?
- NSAIDs
- Hydroxychloroquine
What to do when there are flares and moderate severe disease in SLE?
- oral or intravenous steroids
- steroid sparing agents such as Cyclophosphamide, methotrexate, and azathioprine
- for Severe Lupus Nephritis – Intravenous Pulse cyclophosphamide
Indications for urgent management in SLE?
- Increasing DNA and decreasing complement – which herald an acute flare or new complication
- Flare
- Infection
- New signs of renal involvement – increasing BUN, creatinine, Decreasing creatinine clearance, increasing proteinuria, urine RBCs and WBC casts
SLE presentations and differentials?
- Mental status change – rule out infection and vasculitis
- Leg pain, SOB – rule out Pulmonary embolus
- Ischemic digits – Raynaud phenomenon, Antiphospholipid syndrome, vasculitis, necrosis
- Pregnant patient with flare – both pregnancy and SLE have proteinuria, CNS disease, Hypertension
Note: However in SLE there is low complement and high CRP
Gout is characterized by?
- hyperuricemia
- Recurrent attacks of acute arthritis
- Renal stones
- Tophi
Epidemiology of gout?
Incidence is 1/4000, prevalence 10/1000
Risk factors for gout?
- alcohol
- increasing age (post-adolescent men and postmenopausal women)
- elevated uric acid
- use of diuretics
- over-eating red-meat
Stages of gout?
- asymptomatic
- acute gouty arthritis
- intercritical gout
- Chronic tophaceous gout
Uric acid and gout?
- Normal range of uric acid in serum – 7 to 8mg/dl
- Uric acid increases in – reduced renal function, use of diuretics
Acute gouty arthritis?
Attacks first MTP joint then affects other joints – lasting longer
Triggers of acute gouty arthritis?
- alcohol
- medical illness
- surgical stress
- diuretics
Treatment of acute gouty arthritis?
- NSAIDs
- colchicine
- steroids
Treatment of intercritical gout?
- avoid alcohol
- weight loss
- take colchicine (decrease WBC migration)
- probenecid (uricosuric)
- allopurinol (xanthine oxidase inhibitor)
Features of Chronic tophaceous gout?
Usually appear 10 years after 1st gout attack
Tophi develop with chronic joint pain
Diagnosis of chronic tophaceous gout?
demonstration of the MSU crystals in synovial fluid
Treatment for chronic tophaceous gout?
allopurinol with or without colchicine
What is Tophi?
a core of monosodium urate (MSU) crystal surrounded by inflammatory cells and fibrous capsule
Complications of chronic tophaceous gout?
- renal stones
- proteinuria
- HTN
- chronic renal insufficiency
