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MBBS 3: Internal Medicine > SLE and Gout > Flashcards

SLE and Gout Flashcards

1
Q

Systemic Lupus Erythromatosus?

A
  • 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
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2
Q

Criteria for SLE diagnosis?

A

4 out of SOAP BRAIN MD

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3
Q

SOAP criteria?

A

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

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4
Q

BRAIN criteria?

A

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

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5
Q

MD criteria?

A

Malar rash- fixed erythema over the nose and cheeks
Discoid rash – red, raised, scaling plaques that scar

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6
Q

Other clinical features of SLE?

A
  1. Fatigue
  2. Fever
  3. Weight loss
  4. Myalgias
  5. Urticaria
  6. Non-specific rashes
  7. Peripheral neuropathy
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7
Q

Investigations of SLE?

A
  1. FBC
  2. ESR
  3. CRP
  4. Renal Function Tests
  5. ANA
  6. C3 and C4
  7. Xray
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8
Q

Xray findings in SLE?

A
  1. Soft tissue swelling
  2. Juxta-articular osteopenia
  3. Avascular Necrosis
  4. Reducible subluxations
  5. But NO erosions
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9
Q

Treatment of SLE?

A
  1. NSAIDs
  2. Hydroxychloroquine
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10
Q

What to do when there are flares and moderate severe disease in SLE?

A
  1. oral or intravenous steroids
  2. steroid sparing agents such as Cyclophosphamide, methotrexate, and azathioprine
  3. for Severe Lupus Nephritis – Intravenous Pulse cyclophosphamide
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11
Q

Indications for urgent management in SLE?

A
  1. Increasing DNA and decreasing complement – which herald an acute flare or new complication
  2. Flare
  3. Infection
  4. New signs of renal involvement – increasing BUN, creatinine, Decreasing creatinine clearance, increasing proteinuria, urine RBCs and WBC casts
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12
Q

SLE presentations and differentials?

A
  1. Mental status change – rule out infection and vasculitis
  2. Leg pain, SOB – rule out Pulmonary embolus
  3. Ischemic digits – Raynaud phenomenon, Antiphospholipid syndrome, vasculitis, necrosis
  4. Pregnant patient with flare – both pregnancy and SLE have proteinuria, CNS disease, Hypertension
    Note: However in SLE there is low complement and high CRP
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13
Q

Gout is characterized by?

A
  1. hyperuricemia
  2. Recurrent attacks of acute arthritis
  3. Renal stones
  4. Tophi
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14
Q

Epidemiology of gout?

A

Incidence is 1/4000, prevalence 10/1000

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15
Q

Risk factors for gout?

A
  1. alcohol
  2. increasing age (post-adolescent men and postmenopausal women)
  3. elevated uric acid
  4. use of diuretics
  5. over-eating red-meat
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16
Q

Stages of gout?

A
  1. asymptomatic
  2. acute gouty arthritis
  3. intercritical gout
  4. Chronic tophaceous gout
17
Q

Uric acid and gout?

A
  • Normal range of uric acid in serum – 7 to 8mg/dl
  • Uric acid increases in – reduced renal function, use of diuretics
18
Q

Acute gouty arthritis?

A

Attacks first MTP joint then affects other joints – lasting longer

19
Q

Triggers of acute gouty arthritis?

A
  1. alcohol
  2. medical illness
  3. surgical stress
  4. diuretics
20
Q

Treatment of acute gouty arthritis?

A
  1. NSAIDs
  2. colchicine
  3. steroids
21
Q

Treatment of intercritical gout?

A
  1. avoid alcohol
  2. weight loss
  3. take colchicine (decrease WBC migration)
  4. probenecid (uricosuric)
  5. allopurinol (xanthine oxidase inhibitor)
22
Q

Features of Chronic tophaceous gout?

A

Usually appear 10 years after 1st gout attack
Tophi develop with chronic joint pain

23
Q

Diagnosis of chronic tophaceous gout?

A

demonstration of the MSU crystals in synovial fluid

24
Q

Treatment for chronic tophaceous gout?

A

allopurinol with or without colchicine

25
Q

What is Tophi?

A

a core of monosodium urate (MSU) crystal surrounded by inflammatory cells and fibrous capsule

26
Q

Complications of chronic tophaceous gout?

A
  1. renal stones
  2. proteinuria
  3. HTN
  4. chronic renal insufficiency

MBBS 3: Internal Medicine (72 decks)

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