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BR 3rd Ed > Ch 3 - Rheumatology: Crystal-Induced Synovitis > Flashcards

Ch 3 - Rheumatology: Crystal-Induced Synovitis Flashcards

1
Q

Describe the crystals in gout.

A

Monosodium urate crystals

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2
Q

What does gout affect in joints?

A

Acute synovitis in the synovial membrane and joint cavity

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3
Q

What is seen on joint aspiration in gout?

A

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

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4
Q

Who is affected by gout?

A

Male&raquo_space; Female

Age: 30 to 50 years

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5
Q

What is the sequale of gout?

A
  • Gouty arthritis
  • Acute recurrent attacks
  • Chronic tophaceous arthritis
  • Uric acid calculi
  • Urate nephropathy
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6
Q

Describe the clinical presentation of monoarticular gout.

A

Exquisite pain, warm tender swelling

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7
Q

What is the MC joint involved in monoarticular gout?

A

First MTP joint (podagra)

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8
Q

Which joints are involved in monoarticular gout?

A 
First MTP joint
Midfoot
Ankles
Heels
Knees
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9
Q

Describe Chronic tophaceous gout.

A

– Tophi form after several years of attacks – Cause structural damage to the articular cartilage and adjacent bone

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10
Q

What is involved in polyarticular gout?

A

Olecranon bursae
Wrists
Hands
Renal parenchyma with uric acid nephrolithiasis

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11
Q

What are provocative factors for gout?

A
  • Trauma—influx of synovial fluids urate production
  • Alcohol—increase uric production
  • Drugs—thiazides, ASA
  • Hereditary
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12
Q

What is seen on labwork in gout?

A

Hyperuricemia

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13
Q

What is seen on radiographs in gout?

A

Soft-tissue swelling around the affected joint

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14
Q

What is seen on radiographs in chronic tophaceous gout?

A
  • 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
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15
Q

What is the treatment of an acute gout attack?

A
  • Colchine—inhibits phagocytosis of the urate crystals
  • NSAIDs—Indocin
  • Corticosteroids
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16
Q

What is the treatment of chronic gout?

A
  • Allopurinol
  • Febuxostat
  • Probenecid
17
Q

What does Allopurinol and febuxostat do?

A

Dec synthesis of uric acid

18
Q

What does Probenecid do?

A

Uricosuric increases the renal excretion of uric acid

19
Q

Describe the crystals in pseduogout.

A

CPPD crystals

20
Q

What does pseudogout affect in joints?

A

Hyaline cartilage and fibrocartilage joints

21
Q

What is seen on joint aspiration in pesudogout?

A

Positive birefringence

22
Q

Who is affected by pseudogout?

A

Male > Female

Age: 30 to 50 years

23
Q

What is the sequale of pseudogout?

A
  • Acute pseudogout

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

24
Q

What conditions are associated with pseduogout?

A

hypothyroidism hyperparathyroidism hemochromatosis

amyloidosis hypomagnesemia hypophosphatemia

25
Q

Describe the clinical presentation of pseudogout.

A

Symmetric inflammation in one or more of the large joints

26
Q

What is the MC joint involved in pseduogout?

A

Knee

Flexion contracture common

27
Q

Which joints are involved in pseudogout?

A 
First MTP
Wrist
MCP
Hips
Shoulder
Elbow
Crowded dens syndrom
28
Q

What are provocative factors for pseudogout?

A
  • Hereditary—articular chondrocalcinosis
  • Idiopathic
  • Metabolic disease
  • Trauma
  • Surgery, illness (MI, CVA)
29
Q

What is seen on labwork in pseudogout?

A

Uric acid normal

30
Q

What is seen on radiographs in chondrocalcinosis?

A
  • Punctuate fine lines of crystals in the articular hyaline or fibrocartilage tissue
  • Joint effusions
31
Q

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

A

Narrowing of the femoral tibial joint

32
Q

What is the treatment of pseudogout?

A
  • NSAIDs
  • Corticosteroids
  • Colchicine

BR 3rd Ed (92 decks)

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