What does an X-ray for gout show
- Earliest sign: joint effusion, with relatively preserved joint space
- Well-defined ‘punched out’ erosions with sclerotic margins and overhanging edges in a juxta-articular distribution (rat-bite erosions)
- Eccentric erosions and soft tissue tophi may be observed
- An absenceof periarticular osteopenia (unlike rheumatoid arthritis)
- Late sign: loss of joint space
Prevention of gout
- Lifestyle advice - food low in purine, lose weight, avoid alcohol
- Xanthine oxidase inhibitors - reduces uric acid
- Allopurinol - 1st line
- Febuxostat - 2nd line
Note: when initiating these medications, they should be given at least 2 weeks after an acute attack.
Uricosuric agent - This increases the excretion of uric acid in the urine.
X-ray of pseudogout
- Joint X-ray: chondrocalcinosis (calcification of articular cartilage) is seen in 40% of casesand is highly suggestive of pseudogout but is not diagnostic; theabsenceof chondrocalcinosis doesnotexclude pseudogout
- In the knee, this is seen as linear calcifications of the articular cartilage and meniscus
medication for ankylosing spondylitis (in order)
- NSAIDs e.g. ibuprofen or naproxen (2-4 weeks. If no improvement, switch to another NSAID)
- Steroids- used during flares (oral, IM or directly into joints)
- Anti-TNF e.g. etanercept or monoclonal antibodies against TNF e.g. infliximab, adalimumab
- Monoclonal antibodies targeting IL-7 - e.g. secukinumab
What is SLE
Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune condition caused by a type 3 hypersensitivity reaction due to a complex interplay between genetic and environmental factors.
Treatment of mild SLE
Prednisolone (corticosteroid) + hydroxychloroquine + NSAIDs
Treatment of moderate and severe SLE
Prednisolone and hydroxychloroquine and an immunosuppressant
Immunosuppressents commonly used: Methotrexate, Azathioprine, Ciclosporin
What can you use in refractory cases of SLE
biologics such as belimumab or rituximab may be considered
HLA associations with SLE
B8, DR2, DR3
Antibodies found in SLE
- ANA
- Anti-dsDNA
- Anti-Smith: most specific, low sensitivity
