Ch 3 - Rheumatology: Crystal-Induced Synovitis

Question 1

Describe the crystals in gout.

Answer 1

Monosodium urate crystals

Question 2

What does gout affect in joints?

Answer 2

Acute synovitis in the synovial membrane and joint cavity

Question 3

What is seen on joint aspiration in gout?

Answer 3

Negative birefringence (moderate to severe inflammation WBC 15,000 to 20,000—neutrophils)

Question 4

Who is affected by gout?

Answer 4

Male&raquo_space; Female

Age: 30 to 50 years

Question 5

What is the sequale of gout?

Answer 5

• Gouty arthritis
• Acute recurrent attacks
• Chronic tophaceous arthritis
• Uric acid calculi
• Urate nephropathy

Question 6

Describe the clinical presentation of monoarticular gout.

Answer 6

Exquisite pain, warm tender swelling

Question 7

What is the MC joint involved in monoarticular gout?

Answer 7

First MTP joint (podagra)

Question 8

Which joints are involved in monoarticular gout?

Answer 8

First MTP joint
Midfoot
Ankles
Heels
Knees

Question 9

Describe Chronic tophaceous gout.

Answer 9

– Tophi form after several years of attacks

– Cause structural damage to the articular cartilage and adjacent bone

Question 10

What is involved in polyarticular gout?

Answer 10

Olecranon bursae
Wrists
Hands
Renal parenchyma with uric acid nephrolithiasis

Question 11

What are provocative factors for gout?

Answer 11

• Trauma—influx of synovial fluids urate production
• Alcohol—increase uric production
• Drugs—thiazides, ASA
• Hereditary

Question 12

What is seen on labwork in gout?

Answer 12

Hyperuricemia

Question 13

What is seen on radiographs in gout?

Answer 13

Soft-tissue swelling around the affected joint

Question 14

What is seen on radiographs in chronic tophaceous gout?

Answer 14

• 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

Question 15

What is the treatment of an acute gout attack?

Answer 15

• Colchine—inhibits phagocytosis of the urate crystals
• NSAIDs—Indocin
• Corticosteroids

Question 16

What is the treatment of chronic gout?

Answer 16

• Allopurinol
• Febuxostat
• Probenecid

Question 17

What does Allopurinol and febuxostat do?

Answer 17

Dec synthesis of uric acid

Question 18

What does Probenecid do?

Answer 18

Uricosuric increases the renal excretion of uric acid

Question 19

Describe the crystals in pseudogout.

Answer 19

CPPD crystals

Question 20

What does pseudogout affect in joints?

Answer 20

Hyaline cartilage and fibrocartilage joints

Question 21

What is seen on joint aspiration in pesudogout?

Answer 21

Positive birefringence

Question 22

Who is affected by pseudogout?

Answer 22

Male > Female

Age: 30 to 50 years

Question 23

What is the sequale of pseudogout?

Answer 23

• Acute pseudogout

* Inflammatory host response to CPPD crystals shed from the cartilaginous tissues to the synovial cavity

Question 24

What conditions are associated with pseudogout?

Answer 24

hypothyroidism hyperparathyroidism hemochromatosis

amyloidosis hypomagnesemia hypophosphatemia

Question 25

Describe the clinical presentation of pseudogout.

Answer 25

Symmetric inflammation in one or more of the large joints

Question 26

What is the MC joint involved in pseudogout?

Answer 26

Knee | Flexion contracture common

Question 27

Which joints are involved in pseudogout?

Answer 27

``` First MTP Wrist MCP Hips Shoulder Elbow Crowded dens syndrome ```

Question 28

What are provocative factors for pseudogout?

Answer 28

* Hereditary—articular chondrocalcinosis * Idiopathic * Metabolic disease * Trauma * Surgery, illness (MI, CVA)

Question 29

What is seen on labwork in pseudogout?

Answer 29

Uric acid normal

Question 30

What is seen on radiographs in chondrocalcinosis?

Answer 30

* Punctuate fine lines of crystals in the articular hyaline or fibrocartilage tissue * Joint effusions

Question 31

What does involvement of the menisci of the knee cause in pseudogout?

Answer 31

Narrowing of the femoral tibial joint

Question 32

What is the treatment of pseudogout?

Answer 32

* NSAIDs * Corticosteroids * Colchicine