Commonly encountered rheumatic diseases: crystal arthropathies & polymyalgia rheumatica Flashcards
How are crystal deposition diseases characterised
Depositions of mineralised material within joints and peri-articular tissue
What is the most common crystal seen in practice
Monosodium urate - gout
What condition is monosodium urate linked to
gout
What condition is CPPD - calcium pyrophosphate dihydrate linked to
Pseudogout
What is BCP - basic calcium phosphate hydroxy-apatite linked to
Calcific periarthritis / tendonitis
What is hyperuricaemia caused by
Overproduction
Malignancy
severe exfoliative psoriasis
Drugs such as ethanol
HGPRT deficiency
Under excretion
Renal impairment
hypertension
hypothyroidism
Alcohol
Aspirin
Starvation, dehydration
Lead poisoning
Does alcohol contain purines
Yes it is a major source
What is Lesch Nyan syndrome
HGPRT deficiency which causes an error in purine metabolism
What are some complications of Lesch Nyan syndrome
Intellectual disability
Aggressive and impulsive behaviour
self mutilation
gout
renal disease
Who is gout more common in
Older male
Who is gout not common in
Premenopausal women due to oestrogen
What should be asked in gout history
How long it has lasted, which joint is affected, family history and lifestyle - smoking alcohol and exercise
What should be checked in examination of gout
Will find red hot swollen and swellings at the bursa (usually the olecranon)
What are risk factores for gout
High blood pressure, diabetes and hyper lipidaemia
What is checked in investigation of gout
pull fluid out of joint and do microscopy
X-rays - checking damage to the joint which occurs late and erosions to the bone
Ultrasound can show chronic deposition of uric acid
Bloods can be done to look for uric acid
What drugs can cause gout
Diuretics such as furosemide
Alcohol
What are tophi
Acute accumulations of uric acid
What is the first line, second line and third line treatment of gout
first line - anti-inflammatories
Second line - colchicine - anti-inflammatory
3rd line - steroids - if colchicine does not work
When should gout be treated
If there is a single polyarticular case of gout in one year
If there is more than one attack of gout in a year
If trophaceous gout are present
If ureteric calculi form
What is the first line, second line and 3rd line treatment to lower uric acid
Xanthine oxidase inhibitors - Allopurinol
Febuxostat second line
Uricocuric is 3rd line - probenecid
How do xanthine oxidase inhibitors work
Block the conversion of hypoxanthine to xanthine which reduces urine acid production
What are the rules when using drugs to lower uric acid levels
Wait until the acute attack has settled
What is the prophylactic treatment which is used during the acute attack
NSAIDs or low dose colchicine - anti-inflammatory or steroids until the urate level is normal
What is the correlation and hydration
Being more hydrated reduces chance of gout
Why is gout more common in holidays
The hotter climate making people more dehydrated mixed with more alcohol makes perfect conditions for gout
What area is most commonly affected in gout
toe
What area is most commonly affected by pseudo gout
knee
Who is pseudo gout more common in
Elderly women
What is the correlation between pseudo gout and osteoarthritis
Osteoarthritis puts at risk of developing pseudo gout
How is psuedogout treated
NSAIDS first line
Intra-articular steroids second line
What is giant cell arteritis commonly associated with
Polymyalgia rheumatica
What is the main symptom of polymyalgia rheumatica
Sudden onset of shoulder with or without pelvic girdle stiffness
Which age group is polymyalgia rheumatica rare in
under 50 years of age
Which gender is polymyalgia rheumatica most common in
Females
What is the plasma viscosity seen in polymyalgia rheumatica
1.86
What does polymyalgia rheumatica present with systematically
malaise, weight loss, fever and depression
How is polymyalgia rheumatica diagnosed
No specific diagnostic test
A history that matches normal presentation
Age over 50
Plasma viscosity of 1.86
Dramatic steroid response
What is the treatment for polymyalgia rheumatica
prednisolone 15mg per day over a 18 month to 24 months course
