Term
| gout commonly affects which joint and is known as podogra? |
|
Definition
1st metatarsophalangeal joint.
it also affects
knee
ankle
wrists |
|
|
Term
| radiological features of gout |
|
Definition
soft tissue swelling
tophi may be seen
punched out lesions with sclerotic margins
there is preservation of joint space until late disease
there is no periarticluar osteopenia like there is in RA |
|
|
Term
| some radiological differences between OA, RA and gout |
|
Definition
in gout the joint space is preserved until late disease unlike OA and RA
there is not periarticular osteopenia like there is in RA |
|
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Term
| predisposing factors to gout? |
|
Definition
decreased excretion of uric acid:
due to drugs
ckd
lead toxicity
increased production
psoriasis
cytotoxic drugs
myeloproliferative disorders |
|
|
Term
Lesh-Nyhan syndrome and gout
what are the features? |
|
Definition
x linked recessive so only seen in boys
features: gout, renal failure, neuro deficits, learning difficulties, self mutilation
there is deficiency in hypoxanthine guanine phosphorbosyl transferase, |
|
|
Term
| aspirin can make youth worse but which dose is acceptable to continue in what type of pts? |
|
Definition
| 75mg dose is ok for secondary prevention against stroke, cvs disease |
|
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Term
|
Definition
nsaids
intra articular steroid injection
colchicine (SE: diarrhoea)
oral steroids may be used if colchicine and NSAIDS ci
allopurinol is not for acute gout but if a person is already taking it then it should be continued |
|
|
Term
Allopurinol prophylaxis.
should be started if > 2 attacks in 12 months |
|
Definition
do not start until 2 weeks after acute attack
start 100mg OD and titrate until serum uric acid <300 |
|
|
Term
all indications for allopurinol?
NB: pts with Lesch-Nyhan syndrome take allopurinol for life |
|
Definition
> 2 attacks in 12 month
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxic drugs |
|
|
Term
| lifestyle modifications in gout |
|
Definition
loose weight
reduce alcohol and avoid alcohol in acute attacks
avoid foods high in purines |
|
|
Term
|
Definition
thiazides
furosemide
alcohol
cytotoxic agents
pryrazinamide |
|
|
Term
| MOA and SE of allopurinol |
|
Definition
xanthine oxidase inhibitor
interaction: with azathioprine, can cause increase levels of azathioprine metabolite so if used in combination azathioprine needs to be reduced by 25%
cyclophospahmide: allopurinol reduces clearance of this drug |
|
|
Term
| which condition do some boys have that means they take allopurinol for life? |
|
Definition
| Lesh-Nyhan syndrome, x linked recessive |
|
|
Term
| aspiration findings in gout v psuedogout? |
|
Definition
gout: negative bifringeent needle shaped spindles
psudogout: positively bifringement rhomboid crytsals |
|
|
Term
|
Definition
loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts |
|
|
Term
RA or OA?
pain following use, improves with rest, unilateral symptoms, no systemic upset? |
|
Definition
|
|
Term
RA or OA
morning stiffness, improves with use, bilateral symptoms, systemic upset |
|
Definition
|
|
Term
| common organism causing septic arthritis? |
|
Definition
staph aureus
infection of sternoclavicular and sacroiliac joints commonly caused by GBS |
|
|
Term
| risk factors for septic arthritis? |
|
Definition
increasing age
DM
prior joint damage
joint surgery
hip or knee prosthesis
skin infection
immunosuppresion: HIV |
|
|
Term
| ix of aspirate in septic arthritis? |
|
Definition
WCC
gram stain
culture
polarising microscopy |
|
|
Term
|
Definition
2-3 weeks IV then 2-4 weeks PO
fluclox for staph aureus. if allergic use clindamycin
if MRSA: vancomycin
if gonoccocal: cefotaxime |
|
|
Term
PMR features
ix:
ESR > 40
CK and EMG NORMAL!
reduced CD8 t cells |
|
Definition
usually > 60
rapid onset of symptoms < 1 month
overlap with temporal arteritis
aching, morning stiffness in proximal limbs. NOT WEAKNESS
low grade fever, lethargy, night sweats, depression
mx: prednisolone 15mg od: dramatic response. if not then reconsider diagnosis |
|
|
Term
|
Definition
dx: tender in 11 of 18 points
women 10 x more likely than men
other features: dizziness, headache, lethargy sleep disturbance
mx: aerobic exercise, cbt, Pregabalin, duloxetine amitriptyline |
|
|
Term
Osgood-Schatler syndrome
AKA
Tibial apophysitis |
|
Definition
sporty teenagers
there is pain, tenderness and swelling over tibial tubercle |
|
|
Term
| pain, tenderness and swelling over tibial tubercle in sporty teenager? |
|
Definition
|
|
Term
|
Definition
staph aureus most common
salmonella in sickle cell people
MRI ix of choice
mx: fluclox 6 weeks or clindamycin if allergic |
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