NURP 532-Rheum Exam
Questions And Correct Answers
stages of gout progression - Answer stage 1-high uric acid levels: uric acid builds up in
blood, crystallization in joints
stage 2-acute gout: symptoms start, pain in affected areas
stage 3-intercritical gout:remission between attacks
stage 4-chronic gout: pain is frequent and tophi form in joints
Gout S/S - Answer Rapid onset (pain peaks in 1 day)
Hot, red, swollen joint (usually 1 joint only)
Pain worse at night/rest "bedsheet pain"
PE=Most common locations:
-First metatarsophalangeal joint
-Followed by midtarsal joints, ankles, knees, fingers
Red, hot, exquisitely tender joint
Absence of fever
Tophi in chronic disease
Gout risk factors - Answer -Use of loop or thiazide diuretics
-Men or postmenopausal women (female sex hormones increase excretion of uric acid)
-Increased age
-Black
-Obesity
-Diet: EtOH intake, organ meat, shellfish, sugary food/drinks
dif dx for gout - Answer Septic joint arthritis (fever, elevated WBC; need to get
arthrocentesis if thinking this)
Cellulitis (possible fever/elevated WBC, usually located more over soft tissue)
,Bursitis (profound swelling d/t enlarged bursa)
Lyme (+titres, systemic sx)
Pseudogout (normal serum uric acid levels but +crystals)
Trauma (elicited on history)
Osteoarthritis (chronic onset)
Rheumatoid arthritis (polyarticular, often symmetrical)
diagnosing gout - Answer JOINT FLUID ASPIRATION- Gold standard for Diagnosis
-(AKA Arthrocentesis) Presence of intracellular monosodium urate crystals in synovial
fluid
SERUM URIC ACID- elevated
-Commonly checked but NOT diagnostic of gout
-May be normal or even low during an active flare;
most gout patients will have elevations in between flares
-Therefore, best measured in between flares to monitor response to uric acid
lowering/preventative treatments
Imaging (U/S, MRI, CT) not usually needed unless there is trauma/diagnostic uncertainty
American College of Rheumatology Diagnostic Criteria- Gout - Answer Presence of
characteristic urate crystals in the joint fluid
or
Presence of a tophus proven to contain urate crystals by chemical means or polarized
light microscopy
or
Presence of six or more of the following clinical, laboratory, or radiologic findings:
-Asymmetric swelling within a joint on radiography
-Attack of monoarticular arthritis
-Culture of joint fluid negative for microorganisms during attack of joint inflammation
-Development of maximal inflammation within one day
-Hyperuricemia
-Joint redness
, -More than one attack of acute arthritis
-Pain or redness in the first metatarsophalangeal joint
-Subcortical cyst without erosions on radiography
-Suspected tophus
-Unilateral attack involving first metatarsophalangeal joint
-Unilateral attack involving tarsal joint
Gout tx - Answer acute=NSAIDS, Colchicine, Corticosteroids
prophylactic=Allopurinol, Colchicine, Probenecid
-Initiate if: tophi, hx of kidney stones, 2+ gout flares per year, (1+ flares per year if CKD
stage 2 or higher)
-Goal is to bring uric acid level <6 mg per dL
-Continue 3-6 mons after active flare, indefinitely if there are tophi and/or ongoing sx
-DO NOT start Allopurinol during active gout flare!
non-pharm mgmt of Gout - Answer -encourage weight loss if overweight/obese
-limit sugary foods/ HFCS intake
-avoid ETOH
-limit high purine organ meats (beef, lamb, pork, shellfish)
-inc low fat dairy and vegetables
Juvenile Idiopathic Arthritis (JIA) - Answer assess for=
-Joint redness
-Family history
-Limping/limited movement (can be secondary to pain AND/OR joint contractures)
-Rash (non-pruritic, erythematous, trunk and proximal extremities)
diagnostic criteria for JIA - Answer 1) Onset before age 16 years
2) Arthritis involving one or more joints or at least two of the following findings:
Limitation in range of motion (ROM)
Tenderness or pain with joint movement
Questions And Correct Answers
stages of gout progression - Answer stage 1-high uric acid levels: uric acid builds up in
blood, crystallization in joints
stage 2-acute gout: symptoms start, pain in affected areas
stage 3-intercritical gout:remission between attacks
stage 4-chronic gout: pain is frequent and tophi form in joints
Gout S/S - Answer Rapid onset (pain peaks in 1 day)
Hot, red, swollen joint (usually 1 joint only)
Pain worse at night/rest "bedsheet pain"
PE=Most common locations:
-First metatarsophalangeal joint
-Followed by midtarsal joints, ankles, knees, fingers
Red, hot, exquisitely tender joint
Absence of fever
Tophi in chronic disease
Gout risk factors - Answer -Use of loop or thiazide diuretics
-Men or postmenopausal women (female sex hormones increase excretion of uric acid)
-Increased age
-Black
-Obesity
-Diet: EtOH intake, organ meat, shellfish, sugary food/drinks
dif dx for gout - Answer Septic joint arthritis (fever, elevated WBC; need to get
arthrocentesis if thinking this)
Cellulitis (possible fever/elevated WBC, usually located more over soft tissue)
,Bursitis (profound swelling d/t enlarged bursa)
Lyme (+titres, systemic sx)
Pseudogout (normal serum uric acid levels but +crystals)
Trauma (elicited on history)
Osteoarthritis (chronic onset)
Rheumatoid arthritis (polyarticular, often symmetrical)
diagnosing gout - Answer JOINT FLUID ASPIRATION- Gold standard for Diagnosis
-(AKA Arthrocentesis) Presence of intracellular monosodium urate crystals in synovial
fluid
SERUM URIC ACID- elevated
-Commonly checked but NOT diagnostic of gout
-May be normal or even low during an active flare;
most gout patients will have elevations in between flares
-Therefore, best measured in between flares to monitor response to uric acid
lowering/preventative treatments
Imaging (U/S, MRI, CT) not usually needed unless there is trauma/diagnostic uncertainty
American College of Rheumatology Diagnostic Criteria- Gout - Answer Presence of
characteristic urate crystals in the joint fluid
or
Presence of a tophus proven to contain urate crystals by chemical means or polarized
light microscopy
or
Presence of six or more of the following clinical, laboratory, or radiologic findings:
-Asymmetric swelling within a joint on radiography
-Attack of monoarticular arthritis
-Culture of joint fluid negative for microorganisms during attack of joint inflammation
-Development of maximal inflammation within one day
-Hyperuricemia
-Joint redness
, -More than one attack of acute arthritis
-Pain or redness in the first metatarsophalangeal joint
-Subcortical cyst without erosions on radiography
-Suspected tophus
-Unilateral attack involving first metatarsophalangeal joint
-Unilateral attack involving tarsal joint
Gout tx - Answer acute=NSAIDS, Colchicine, Corticosteroids
prophylactic=Allopurinol, Colchicine, Probenecid
-Initiate if: tophi, hx of kidney stones, 2+ gout flares per year, (1+ flares per year if CKD
stage 2 or higher)
-Goal is to bring uric acid level <6 mg per dL
-Continue 3-6 mons after active flare, indefinitely if there are tophi and/or ongoing sx
-DO NOT start Allopurinol during active gout flare!
non-pharm mgmt of Gout - Answer -encourage weight loss if overweight/obese
-limit sugary foods/ HFCS intake
-avoid ETOH
-limit high purine organ meats (beef, lamb, pork, shellfish)
-inc low fat dairy and vegetables
Juvenile Idiopathic Arthritis (JIA) - Answer assess for=
-Joint redness
-Family history
-Limping/limited movement (can be secondary to pain AND/OR joint contractures)
-Rash (non-pruritic, erythematous, trunk and proximal extremities)
diagnostic criteria for JIA - Answer 1) Onset before age 16 years
2) Arthritis involving one or more joints or at least two of the following findings:
Limitation in range of motion (ROM)
Tenderness or pain with joint movement
