Vasculitis Flashcards
What is Gout
- crystal arthropathy associated with chronically high blood uric acid levels.
- Urate crystal deposited in the joints
- Monoarthopathy
What is the common presentation of gout
- Unilateral, hot swollen, painful joint
- RULE OUT septic arthritis
Which joint is most affected by gout
Base of big toe (metatarso-phalangeal joint)
Wrists
Base of thumb
( knee and ankle)
What are the risk factors for gout
Male Obesity High purine diet (e.g. meat and seafood) Alcohol Diuretics Existing cardiovascular or kidney disease Family history
What will aspiration of gout show
No bacterial growth
Needle shaped crystals
Negative birefringent of polarised light
Monosodium urate crystals
What might you see on xray of a joint with gout
Typically the space between the joint is maintained
Lytic lesions in the bone
Punched out erosions
Erosions can have sclerotic boarders with overhanding edges
What is the management of an acute flare of gout
NSAIDs (e.g. ibuprofen) are first line
Colchicine second line (can’t have NSAIDs (renal))
Steroids can be considered third line
How can you prevent further episodes of gout
- Allopurinol
What is allopurinol
- xanthine oxidate inhibitor use for the prophylaxis of gout. It reduces uric acid level.
- Do NOT initiate during an acute flare
- Once initiated can be continued during another flare
What lifestyle changes can reduce the risk of recurrent gout
- Weight loss
- staying hydrated
- Reduce alcohol
- reduce purine-based food (such as meat and seafood).
What is pseudogout
- crystal arthropathy caused by calcium pyrophosphate crystals
- Calcium pyrophosphate crystals are deposited in the joint causing joint problems
- AKA. chondrocalcinosis.
What is the presentation of pseudogout
- older adult with a hot, swollen, stiff, painful knee
- Can affect shoulders, wrists and hips
What will fluid aspiration of pseudogout show
No bacterial growth
Calcium pyrophosphate crystals
Rhomboid shaped crystals
Positive birefringent of polarised light
What Xray findings may you see in a patient with pseudogout
L – Loss of joint space O – Osteophytes S – Subarticular sclerosis S – Subchondral cysts - Chondrocalcinosis
What is the management of pseudogout
- Symptoms usually resolve spontaneously over several weeks.
- NSAIDs
- Colchicine
- Joint aspiration
- Steroid injections
- Oral steroids
What is polymyalgia Rheumatica
PMR, is a relatively common condition that causes stiffness and pain in muscles. The word ‘poly’ means many and the word ‘myalgia’ means muscle pain.
What is Polymyalgia Rheumatica associated with?
- temporal arteritis
- histology shows vasculitis with giant cells, skip lesions
- muscle bed arteries affected most in polymyalgia rheumatica
Features of polymyalgia rheumatica
- typically > 60 years old
- rapid onset (e.g. < 1 month)
- aching
- morning stiffness in proximal limb muscles
- NO WEAKNESS
- mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
What investigations should be done if suspected polymyalgia rheumatica
- ESR > 40 mm/hr
- Creatine kinase normal
- EMG normal
What is the treatment of polymyalgia rheumatica
prednisolone e.g. 15mg/od - dramatic response
Side effects of methotrexate
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis
How long should contraception be used following methotrexate
6 months after cessation of drugs
Key advise for methorexate
- avoid pregnancy for 6 months
- taken weekly
- monitoring
- Folate acid 5mg weekly on a diff. day to methotrexate
What monitoring should be undertaken when starting methotrexate
- FBCs, LFTs & U&Es
- Weekly until stabilised
- every 2-3 months
Key interactions with methotrexate
- Trimethoprim
- co-trimoxazole
- high dose aspirin
Can sulfasalazine be used in pregnancy and breast feeding
yes
What are the side effects of sulfasalazine
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis
Who should not be prescribed sulfasalazine
- G6PD deficiency
- ## allergy to aspirin or sulphonamides (cross-sensitivity)
