Ch 3 - Rheumatology: Crystal-Induced Synovitis Flashcards
Describe the crystals in gout.
Monosodium urate crystals
What does gout affect in joints?
Acute synovitis in the synovial membrane and joint cavity
What is seen on joint aspiration in gout?
Negative birefringence (moderate to severe inflammation WBC 15,000 to 20,000—neutrophils)
Who is affected by gout?
Male»_space; Female
Age: 30 to 50 years
What is the sequale of gout?
- Gouty arthritis
- Acute recurrent attacks
- Chronic tophaceous arthritis
- Uric acid calculi
- Urate nephropathy
Describe the clinical presentation of monoarticular gout.
Exquisite pain, warm tender swelling
What is the MC joint involved in monoarticular gout?
First MTP joint (podagra)
Which joints are involved in monoarticular gout?
First MTP joint Midfoot Ankles Heels Knees
Describe Chronic tophaceous gout.
– Tophi form after several years of attacks
– Cause structural damage to the articular cartilage and adjacent bone
What is involved in polyarticular gout?
Olecranon bursae
Wrists
Hands
Renal parenchyma with uric acid nephrolithiasis
What are provocative factors for gout?
- Trauma—influx of synovial fluids urate production
- Alcohol—increase uric production
- Drugs—thiazides, ASA
- Hereditary
What is seen on labwork in gout?
Hyperuricemia
What is seen on radiographs in gout?
Soft-tissue swelling around the affected joint
What is seen on radiographs in chronic tophaceous gout?
- Tophi appear as nodules in lobulated soft tissue masses
- Bone erosions develop near the tophi just slightly removed from the periarticular surface, developing overhanging margins
What is the treatment of an acute gout attack?
- Colchine—inhibits phagocytosis of the urate crystals
- NSAIDs—Indocin
- Corticosteroids
What is the treatment of chronic gout?
- Allopurinol
- Febuxostat
- Probenecid
What does Allopurinol and febuxostat do?
Dec synthesis of uric acid
What does Probenecid do?
Uricosuric increases the renal excretion of uric acid
Describe the crystals in pseudogout.
CPPD crystals
What does pseudogout affect in joints?
Hyaline cartilage and fibrocartilage joints
What is seen on joint aspiration in pesudogout?
Positive birefringence
Who is affected by pseudogout?
Male > Female
Age: 30 to 50 years
What is the sequale of pseudogout?
- Acute pseudogout
* Inflammatory host response to CPPD crystals shed from the cartilaginous tissues to the synovial cavity
What conditions are associated with pseudogout?
hypothyroidism hyperparathyroidism hemochromatosis
amyloidosis hypomagnesemia hypophosphatemia
Describe the clinical presentation of pseudogout.
Symmetric inflammation in one or more of the large joints
What is the MC joint involved in pseudogout?
Knee
Flexion contracture common
Which joints are involved in pseudogout?
First MTP Wrist MCP Hips Shoulder Elbow Crowded dens syndrome
What are provocative factors for pseudogout?
- Hereditary—articular chondrocalcinosis
- Idiopathic
- Metabolic disease
- Trauma
- Surgery, illness (MI, CVA)
What is seen on labwork in pseudogout?
Uric acid normal
What is seen on radiographs in chondrocalcinosis?
- Punctuate fine lines of crystals in the articular hyaline or fibrocartilage tissue
- Joint effusions
What does involvement of the menisci of the knee cause in pseudogout?
Narrowing of the femoral tibial joint
What is the treatment of pseudogout?
- NSAIDs
- Corticosteroids
- Colchicine
