Clinical Approach- Joint Pain II

Question 1

What is crystal-induced arthropathy?

Answer 1

Crystals (like gout) deposit in your joints –> inflammation and pain

Question 2

Does gout affect more males or females?

Answer 2

Males

Question 3

High levels of ________ in the blood predisposes you to gout?

Answer 3

Uric acid ( > 6.8 mg/dL)

Question 4

Food high in _____ can precipitate gout?

Answer 4

Purines

red meat, shellfish, beer and beans

Question 5

Which diuretic increases risk of gout?

Answer 5

Thiazide diuretics

Question 6

Describe the pathogenesis of gout

Answer 6

Supersaturation of uric acid –> crystal formation –> activates immune system –> increased IL-B1

Question 7

Is hyperuricemia usually caused by overproduction or underexcretion of uric acid?

Answer 7

Underexcretion

Question 8

Does everyone with hyperuricemia develop gout?

Answer 8

Only 20%

Question 9

WHat are the two precursors for uric acid?

Answer 9

Adenine and Guanine (the two purines)

Question 10

What is the pattern of onset of gout?

Answer 10

Acute “attacks” or “flairs” - usually monoarticular (but could be poly) that resolves in days to weeks

Question 11

What is definitive diagnosis of gout?

Answer 11

Demonstration of crystal deposition on polarized microscopy (they are negative birefringent)

Question 12

What are tophi?

Answer 12

Sheets/clumps of crystals in the joints

Question 13

What are the go-to’s for treatment of and acute flair of gout?

Answer 13

NSAIDS, corticosteroids, anti IL-1

Question 14

How do we prevent a relapse of gout?

Answer 14

Colchicine, NSAIDS

Question 15

How do we decrease uric acid levels?

Answer 15

xanthine oxidase inhibitors

Question 16

Pseudogout is the deposition of what crystals?

Answer 16

Calcium pyrophosphate dihydrate

Question 17

How does pseudogout present differently from gout?

Answer 17

Location of crystals- less podagra, knees and wrists are more involved

Inflammation is less severe

Question 18

What does chondrocalcinosis on x-ray imply?

Answer 18

Can be pseudogout, or could be asymptomatic

Question 19

Who gets pseudogout?

Answer 19

The eldery

Question 20

Is pseudogout a primary or secondary disease?

Answer 20

Can be either

Could be secondary to hemochromatosis, hyperparathyroidism, hypophosphatasia, or hypomagnesia

Question 21

Where does chondrocalcinosis most commonly appear?

Answer 21

Triangular cartilage of the wrist

Question 22

Contrast the appearance of gout vs CPPD/pseudogout

Answer 22

Crystals in pseudogout are smaller and harder to see

Question 23

Why are calcium phosphate crystals hard to see?

Answer 23

They don’t show up under polarized light?

Question 24

What is a “milwaukee shoulder?”

Answer 24

Hydroxyapatite associated destructive arthritis

Occurs in elderly females with destruction of the rotator cuff and glenohumeral joint

Question 25

What type of disorder is polymyalgia rheumatica?

Answer 25

Autoimmune disorder?

Question 26

How does polymyalgia rheumatica present?

Answer 26

Pain and stiffness in proximal joints and muscles --> shoulders and hips, neck muscles

Question 27

Name three markers of inflammation that are upregulated in polymyalgia rheumatica

Answer 27

IL-6, ESR and CRP

Question 28

What is the treatment for polymyalgia rheumatica?

Answer 28

Corticosteroids (prednisone) | Steroid sparing agents (methotrexate)

Question 29

What is the most common benign neoplasm of the synovium?

Answer 29

Tenosynovial Giant Cell Tumor

Question 30

Which joint is affected most by tenosynovial giant cell tumors?

Answer 30

Knee (80%)

Question 31

Which is a key finding to look for histologically for the diagnosis of tenosynovial giant cell tumor?

Answer 31

multiple hemosiderin-laden macrophages | +osteocyte

Question 32

What is the problem in tenosynovial giant cell tumors?

Answer 32

Overproliferation of cells in synovium

Question 33

What is the treatment for tenosynovial giant cell tumors

Answer 33

Surgical excision

Question 34

Are gout crystals needle shaped or rhomboid shaped?

Answer 34

Needle shaped