Glomerulonephritis (usually mesangial)

Nephrotic synd (2° to amyloidosis)

•  Approach:

• if ≥2 attacks/y, ≥1 tophus, joint erosions or urolithiasis →
• start urate lowering Rx &
• pharmacologic prophylaxis to ↓ risk of acute attacks

nonpurine xanthine oxidase inhibitor

2nd line: use if allopurinol intolerant

Pegloticase (IV)

MA: Recombinant uricase

I: for refracctory tophaceus gout, infusion reactions (including anaphylaxis)

CALCIUM PYROPHOSPHATE DIHYDRATE (CPPD) DEPOSITION DISEASE

Metabolic etiologies: (Pocket)

 Most cases idiopathic;

consider further metabolic eval in young (<50 y) and florid forms

•  Metabolic (3 H’s):

hemochromatosis;

 hyperparathyroidism;

hypomagnesemia (esp. In Gitelman’s or Bartter’s syndromes)

•  Extraglandular manifestations:

• arthritis;

• interstitial nephritis (40%);

• type I RTA (20%);

• cutaneous vasculitis (25%);

• neuropathies (10%);

• PNS (peripheral nervous system) or CNS disease;

• ILD;

• PBC

•  ↑ risk of lymphoproliferative disorders (~50× ↑ risk of lymphoma and WM in 1° Sjögren’s)

Classification criteria (2 of 3 have 93% Se & 95% Sp; Arthritis Care Res 2012;64:475)

1. [+]

• anti-Ro or

• anti-La or
• RF + ANA>1:320

2. Labial salivary gland bx w/ lymphocytic sialadenitis and score >1 focus/4 mm2

3. Keratoconjunctivitis sicca w/ ocular staining score ≥3

•  Severe:

• PDE inhibitors,
• anti-ET-1 receptor (if ulcers esp. w/ PHT),
• digital sympathectomy

•  Digit-threatening:

• IV prostaglandins,

• digital sympathectomy, ± anticoagulation

• Ddx for >100:
• malignancy esp. Multiple myeloma, lymphoma;
• GCA or other vasculitis;
• ESRD;
• endocarditis, TB, osteomyelitis