Commonly Encountered Rheumatic Disease

Question 1

Define crystal deposition disease and name 3 types.

Answer 1

The deposition of mineralised material within joints and peri-articular tissue.

1. Gout (Monosodium Urate)
2. Pseudogout (Calcium pyrophosphate dihydrate - CPPD)
3. Calcific peri-arthritis/tendonitis (Calcium phosphate hydroxy-apatite -BCP)

Question 2

What is the purpose of hypoxanthine-guanine phosphoribosyl transferase (HGPRT)?

Answer 2

Plays a role in recycling of purine bases hypoxanthine and guanine into the purine nucleotide pool

Question 3

Give some causes for the overproduction of urate

Answer 3

Malignancy
Severe exfoliative psoriasis 
Drugs
Inborn metabolism errors
HGPRT deficiency

Question 4

Give some causes of under secretion of urate

Answer 4

Renal impairment
Hypertension
Hypothyroidism
Drugs
Exercise, starvation and dehydration.
Lead poisoning

Question 5

What is Lesch Nyhan Syndrome?

Answer 5

A HGPRT deficiency

Question 6

What are the signs of Lesch Nyhan syndrome?

Answer 6

Almost exclusively occurs in males
Intellectual disability
Aggresive and impulsive behaviour
Gout
Renal disease

Question 7

How would you manage an acute gout flare up?

Answer 7

NSAIDs
Colchicine
Steroids

Question 8

Name a drug that will lower uric acid

Answer 8

Allopurinol (Xanthine Oxidase Inhibitor)

Question 9

What is Polymyalgia Rheumatica?

Answer 9

An inflammatory condition of the elderly commonly associated with giant cell arteritis

Question 10

What are the diagnostic features of Polymyalgia Rheumatica?

Answer 10

> 50 y/o
ESR > 50
Dramatic steroid response

Question 11

How would you treat polymyalgia Rheumatica?

Answer 11

Prednisalone 15mg per day initially
18-24 month course
Bone prophylaxis