Smart Phrases And Workups – Rheum

GOUT	
Gout
- f/u arthrocentesis for small negatively birefringent rhomboid crystals
- f/u x-ray for chondrocalcinosis
- colchicine 1.2 mg x1 then 0.6 mg 1h later then 0.6 mg QD until 2-3 days after symptom resultion
- urate lowering tx if 2+ attacks/year
- avoid diuretics, red meat, seafood, alcohol

CPPD 	
CPPD
- f/u arthrocentesis for small + birefringent rhomboid crystals
- f/u x-ray for chondrocalcinosis
- colchicine 1.2 mg x1 then 0.6 mg 1h later then 0.6 mg QD until 2-3 days after symptom resultion
IgG4 Disease	

SEPTIC ARTHRITIS	
Septic Arthritis
P/w ***
T ***, WBC *** (50-150k)
- ortho consulted, appreciate recs
- f/u arthrocentesis with gram stain and Cx
- plan for drainage/washout
- abx for 3-4 weeks

VASCULITIS	
Vasculitis
Small vessel (leukocytoclastic vasculitis) most common
Etiologies: drug-induced, connective tissue disease, infections, malignancy
- f/u CBC w/diff, BMP, LFTs, UA, HBV, HCV, cryo, ANA, C3/C4, dsDNA, RF, ANCA
- for flare: steroids + cyclophosphamide (or ritiximab for ANCA-associated; Lancet 2006;368:404)
- rheum consult, appreciate recs. Consider maintenance with ZAZ, MTX, MMF, or rituximab
GOUT
Gout
- f/u arthrocentesis for small negatively birefringent rhomboid crystals
- f/u x-ray for chondrocalcinosis
- colchicine 1.2 mg x1 then 0.6 mg 1h later then 0.6 mg QD until 2-3 days after symptom resultion
- urate lowering tx if 2+ attacks/year
- avoid diuretics, red meat, seafood, alcohol

CPPD
CPPD
- f/u arthrocentesis for small + birefringent rhomboid crystals
- f/u x-ray for chondrocalcinosis
- colchicine 1.2 mg x1 then 0.6 mg 1h later then 0.6 mg QD until 2-3 days after symptom resultion
IgG4 Disease

SEPTIC ARTHRITIS
Septic Arthritis
P/w ***
T ***, WBC *** (50-150k)
- ortho consulted, appreciate recs
- f/u arthrocentesis with gram stain and Cx
- plan for drainage/washout
- abx for 3-4 weeks

VASCULITIS
Vasculitis
Small vessel (leukocytoclastic vasculitis) most common
Etiologies: drug-induced, connective tissue disease, infections, malignancy
- f/u CBC w/diff, BMP, LFTs, UA, HBV, HCV, cryo, ANA, C3/C4, dsDNA, RF, ANCA
- for flare: steroids + cyclophosphamide (or ritiximab for ANCA-associated; Lancet 2006;368:404)
- rheum consult, appreciate recs. Consider maintenance with ZAZ, MTX, MMF, or rituximab

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