Arthritis Awareness Month

Content

• Low Back Pain
• Gout
• Symptoms And Signs
• Other Topics In Patient Care & Health Info
• Acute Gouty Arthritis
• Create A File For External Citation Management Software

To reduce this undesired effect, colchicine or low-dose NSAID treatment is provided for at least 6 months. In patients who cannot take colchicine or NSAIDs, low doses of prednisone can be considered. When used prophylactically, colchicine can reduce such flares by 85%. Patients with gout may be able to abort an attack by taking a single colchicine tablet at the first twinge of an attack. Attacks of acute gouty arthritis should be treated with pharmacologic therapy, preferably initiated within 24 hours of onset.

In patients aged 65 years or older, the primary endpoint was achieved in 62% on febuxostat 40 mg/day, 82% on febuxostat 80 mg/day, and 47% on allopurinol. These figures remained essentially unchanged in subjects with mild-to-moderate renal impairment. Intra-articular long-acting corticosteroids are particularly useful in patients with a monoarticular flare to help reduce the systemic effects of oral steroids. Ensuring that the joint is not infected before injecting intra-articular corticosteroids is particularly important. Prednisone can be given at a dose of approximately 40 mg for 1-3 days, which is then tapered over approximately 2 weeks .

Low Back Pain

Specificity, on the other hand, is very high and makes radiographs reasonably accurate . If tophi are seen, they generally appear as an area of increased opacity in a round, ill-defined shape . The use of POCUS in family medicine has been increasing because it improves clinical outcomes, reduces costs, improves the accuracy and efficacy of procedures, and improves patient satisfaction, especially in resource-limited areas [7-9]. Advances in technology and availability of equipment, as well as decreased size of ultrasound units, have fueled its adoption by clinicians. In addition, POCUS can provide real-time information at the bedside and avoids ionizing radiation. Due to this potential, the American Association of Family Physicians has published a POCUS curriculum for family medicine residencies that describes the scope of practice, competencies, and skills of POCUS for the family physician .

Gout

Additionally, a prolonged PR interval can be seen on electrocardiography. Acute rheumatic fever is a delayed sequela of pharyngitis due to Streptococcus pyogenes, which are also called group A Streptococcus or group A strep. The etiology, clinical features, diagnosis and treatment options, prognosis and complications, and prevention are described below. Do not underestimate this shelf; it can be pretty hard, especially if you’re taking it before Medicine, Pediatrics, and Ob/Gyn. Know your common chronic diseases and musculoskeletal diseases very well because they come up very often on the shelf. Treatment guidelines for diseases like hypertension, hyperlipidemia, diabetes, and asthma will be covered.

Symptoms And Signs

Thus, people with group A strep pharyngitis should stay home from work, school, or daycare until afebrile and until at least 12 hours after starting appropriate antibiotic therapy. Subcutaneous nodules and erythema marginatum are the two major skin manifestations. Subcutaneous nodules are firm, painless, variable in size , and usually found over joint extensor surfaces. Acute rheumatic fever is usually characterized by fever and affects multiple organ systems. Patient resources include the University of Michigan FibroGuide and the Arthritis Foundation patient information page. The minimum tests recommended are creatinine, calcium, aspartate aminotransferase , alanine aminotransferase , thyroid-stimulating hormone , complete blood cell count, urinalysis, and basic metabolic panel .

Gout is an inflammatory process associated with the formation and reversible deposition of uric acid in the joints, and extra-articular tissues of the body. Classic presenting features include severe pain, swelling, erythema, and disability but rarely causes joint destruction. Risk factors comprised excessive alcohol use, male gender, dehydration, trauma, surgery, metabolic disorders (e.g., diabetes), hypertension, chronic kidney disease, and drugs that can predispose the patient to a gout flare. Diagnostic confirmation is with the evaluation of synovial fluid aspirate of the affected joint and visualization of intracellular MSU crystals under the polarized light. The gold standard for the diagnosis of gout is the detection of negatively birefringent monosodium urate crystals from synovial fluid or soft tissue/tophus aspirate. In addition, the synovial fluid analysis may not reveal MSU crystals in a significant (up to 25%) portion of patients with acute gout .

Uricosuric drugs should not be given to patients with a urine output of less than 1 mL per minute, a creatinine clearance of less than 50 mL per minute (0.84 mL per second) or a history of renal calculi. The physiologic decline in renal function that occurs with aging frequently limits the use of uricosuric agents. Side effects from allopurinol include rash, gastrointestinal problems, headache, urticaria and interstitial nephritis.

Numerous previous studies have questioned the efficacy or protection afforded by hydroxychloroquine for COVID-19 and studies have show that HCQ has failed when given as post-exposure prophylaxis to health care workers . A new randomized controlled trial has shown that HCQ failed when given as 8 weeks of pre-exposure prophylaxis in hospital-based HCWs exposed to patients with COVID-19 patients. The contents of this website are for informational purposes only and do not constitute medical advice.CreakyJoints.org is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The news about dexamethasone benefitting some COVID-19 patients should not have any bearing on your decision to use this drug or other corticosteroids for rheumatic disease. The findings — which still require objective vetting and replication in other studies — only apply to people who are seriously ill with this virus.

Migratory Arthritis

For patients with gout who require treatment to lower their uric acid level, allopurinol is a safer option than febuxostat. Oral corticosteroids and nonsteroidal anti-inflammatory drugs are equally effective in the treatment of acute gout. The presence of 2 major manifestations or 1 major and 2 minor manifestations indicates a high probability of an initial acute rheumatic fever illness in any risk population.

Essential Thrombocytosis; Primary Thrombocythemia

Indications for chronic urate-lowering therapy include chronic kidney disease, two or more flares per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage. Although serum urate targets should be defined for individual patients, the minimum level is less than 6 mg per dL (357 μmol per L). Lowering serum urate levels below 5 mg per dL (297 μmol per L) may be necessary to improve signs and symptoms of gout. Once preferred serum urate target levels have been reached, long-term management goals include continuance of gout prophylaxis if there are ongoing symptoms or signs of the condition. Physicians should regularly monitor serum urate levels and monitor for adverse effects of urate-lowering therapy.

- increased protein excretion in the upright position, but normal protein excretion when the patient is supine. - diagnosed using split urine collections as described in the question - a benign condition with normal renal function, no further evaluation is necessary. Loop diuretics should be used, instead of thiazide diuretics, to treat hypertension in patients with moderate to severe renal impairment. In patients with normal renal function, loop diuretics are less effective than thiazide diuretics for the treatment of hypertension.

Create A File For External Citation Management Software

Consumption of vegetables and low-fat or nonfat dairy products should be encouraged. The use of loop and thiazide diuretics can increase uric acid levels, whereas the use of the angiotensin receptor blocker losartan increases urinary excretion of uric acid. Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout, and colchicine and/or probenecid are reserved for patients who cannot tolerate first-line agents or in whom first-line agents are ineffective.