Arthritic conditions Flashcards
1
Q
Define pseudogout?
A
- A metabolic disease resulting from desposition of CALCIUM PYROPHOSPHATE DIHDRATE (CPPD) crystals within the joint space
- Characterised by recurrent monoarticular arthritis
2
Q
What is the epidemiology of pseudogout?
A
- Commonly affects the elderly
- rarely affects the young
3
Q
Name associated conditions?
A
- Haemochromatosis
- Hyperparathyroidism
- SLE
- Gout
- RA
- Wilson’s disease
- Haemophilia
- Long term haemodialysis
- Chondrocalcinosis present in 7%
4
Q
How is it different form gout?
A
- Affects older patient >60 yrs
- Affects more proximal joints
- weakly Positive befringement crystals
5
Q
Describe the symptoms and signs?
A
Symptoms
- Acute onset joint tenderness
- warm , erythermatous joint
- Commonly on knee and wrist joint
Signs
- Erythermatous, monoarticular arthritis
- Joint tenderness to palpation
- May observe superficial mineral deposits under skin at affected joints
6
Q
What is seen on xrays?
A
- Chondrocalcinosis- calcification of fibroartilage structures
- TFCC in wrist
- Mensicus in knee
7
Q
How is pseudogout dx?
A
- Weakly POSTIVE BIFEFRINGENT RHOMBOID shaped crystals
8
Q
What is the tx of acute gout?
A
- Acute
- NSAIDS
- Splints for comfort
- Chronic
- Non operative
- Intra-articular yttrium-90 injection
-
cochicine- 0.6mg PO for recurrent cases
- prophylatic cochicine can help to prevent recurrence
9
Q
Complications of pseudogout?
A
- Can result in permanent damage to joints and renal disease
NB PSEUDO GOUT “P” for
- postive birefringent rhombpid crystals
- calcium Pyrophosphate dihydrate
10
Q
What is the epidemiology of ankle arthritis?
Describe the pathophysiology of ankle arthritis?
A
- Less common than OA of knee/hip
-
Post traumatic arthritis
- Greater than 2/3 ankle arthritis
- Primary OA- Less than 10%
- RA
- Osteonecrosis
- Septic arthritis
- Gout
11
Q
What is the pathoanatomy of ankle arthritis?
A
- Nonanatomic fracture healing alters the joint reaction forces of the ankle and changes the load bearing mechanics of the ankle joint
- Loss of cartilage on the talus and tibial plafound-> joint space naarowing, sunchondral sclerosis and Eburnation
12
Q
Decribe the anatomy of the ankle joint?
A
- Ginglymus joint- HINGE
- Talar dome is biconcave with a central sulcus
- Dorsiflexion 20o
- Plantarflexion 50o
13
Q
What are the signs and symptoms of ankle arthritis?
A
Symptoms
- Pain on weight bearing
- Reduction in motion
Signs
- Joint effusion
- reduced ROM cf contralateral side
- Angular deformity if hx of trauma
14
Q
What investigations are useful?
A
Radiographs
- AP standing, lateral standing, oblique
- Loss of joint space, subchondrial sclerosis, Eburnation, possible angular deformity
15
Q
What is the tx for ankle arthritis?
A
- Nonoperative
- activity modification, bracing to immobilise ankle,NSAIDS
- single rocker can improve things
- Surgery
-
Debridement with anterior tibial/dortsal talectomy
- Mild disease/ pai onpush off
- Distraction arthroplasty
-
Supramalleolar osteotomy
- medial focused ankle pain
-
Arthrodesis
- eldery less active patient
-
Arthroplasty
- Post-traumatic/ inflammatory arthritis/ eldery pt
- Pt selection is key