Crystal arthopathy Flashcards

1
Q

How are crystal arthropathies characterised?

A

Characterised by deposition of mineralised material within joints and peri-articular tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three common crystal arthropathies?

A
  • GOUT: Monosodium urate
  • PSEUDOGOUT: Calcium pyrophosphate dihydrate (CPPD)
  • Calcific periarthritis/tendonitis: Basic calcium phosphate hydroxy-apatite (BCP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Please briefly explain purine metabolism and how this contributes to gout:

A
  • Endogenous production of uric acid from degradation of purines usually contributes about two-thirds of the body urate pool, the remainder being dietary in origin.
  • Of the uric acid produced daily, the majority (∼ 70%) is excreted via the kidney and the remainder is eliminated into the biliary tract and subsequently converted by colonic bacterial uricase to allantoin.
  • In the vast majority of people with gout, hyperuricaemia results from reduced efficiency of renal urate clearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gout is caused by hyperuricaemia - what are reasons for overproduction of urate?

A
  • Malignancy e.g lymphoproliferative, tumour lysis syndrome
  • Severe exfoliative psoriasis
  • Drugs e.g. ethanol, cytotoxic drugs
  • Inborn errors of metabolism
  • HGPRT deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gout is caused by hyperuricaemia - what are reasons for underexcretion of urate?

A
  • Renal impairment
  • Hypertension
  • Hypothyroidism
  • Drugs e.g. alcohol, low dose aspirin, diuretics, cyclosporin
  • Exercise, starvation, dehydration
  • Lead poisoning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who is most likely to be effected by gout?

A
  • It is predominantly a disease of older men.
  • Men have higher urate levels than women and an increased prevalence of gout at all ages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of an acute flare of Gout?

A
  • NSAIDs
  • Colchicine
  • Steroids: I/A, I/M, oral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of hyperuricaemia causing chronic gout?

A
  • Does it need to be treated ?
  • 1st attack not treated unless;
    • Single attack of polyarticular gout
    • Tophaceous gout
    • Urate calculi
    • Renal insufficiency
  • Treat if 2nd attack within 1 yr
  • Prophylactically prior to treating certain malignancies
  • DO NOT treat asymptomatic hyperuricaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharmacological treatment of hyperuricaemia?

A
  • Xanthine oxidase inhibitor e.g. Allopurinol
  • Febuxostat
  • Uricosuric agents e.g. sulphinpyrazone, probenecid, benzbromarone
  • Canakinumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rules for lowering uric acid levels?

A
  • Wait until the acute attack has settled before attempting to reduce the urate level
  • Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
  • Adjust allopurinol dose according to renal function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are lifestyle factors that contribute to gout?

A
  • Seafood consumption
  • Meat consumption
  • Alcohol consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is pseudogout?

A
  • Calcium pyrophosphate arthritis is caused by deposition of calcium pyrophosphate (CPP) crystals.
  • It can be difficult to diagnose as CPP crystals in synovial fluids can be small, sparse, and difficult to find.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who is more likely to get pseudogout?

A
  • Elderly females
  • Erratic flares
  • Aetiology
    • Idiopathic, familial, metabolic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are triggers of pseudogout?

A
  • Trauma, Intercurrent illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management of pseudogout?

A
  • NSAIDs
  • I/A steroids
  • There are no prophylactic therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is polymyalgia rheumatica?

A
  • Inflammatory condition of the elderly. There is a close relationship wth GCA (most common of the systemic vasculitides characterised by involvement of the large vessels).
17
Q

Please note the relationship between GCA and polymyalgia rheumatica:

A
18
Q

What are characteristics of Polymyalgia Rheumatica?

A
  • SUDDEN onset of shoulder +/- pelvic girdle STIFFNESS
  • Rare < 50y usually > 70y
  • F:M 2:1
  • ESR usually > 45 often 100
  • Anaemia
  • Malaise ; Weight loss ; fever; depression
  • Arthralgia / synovitis occasionally
19
Q

What is the diagnostic criteria for polymyalgia rheumatica?

A
  • Compatible history
  • Age > 50
  • ESR > 50
  • Dramatic steroid response
  • No specific diagnostic test
20
Q

DDx for polymyalgia rheumatica?

A
  • Myalgic onset Inflammatory joint disease
  • Underlying malignancy
    • e.g Multiple myeloma, lung cancer
  • Inflammatory muscle disease
  • Hypo/ hyperthyroidism
  • Bilateral shoulder capsulitis
  • Fibromyalgia
21
Q

Tx for polymyalgia rheumatica?

A
  • Prednisolone 15mg per day initially
  • 18-24 mth course
  • Bone prophylaxis
22
Q

What do we need to know from this lecture:

A
  • Aware of the different crystal deposition diseases and their presentation
  • Basic understanding of why hyperuricaemia may occur
  • Know how to manage an acute attack of gout
  • Know how to manage hyperuricaemia
  • Recognise the signs and symptoms of Polymyalgia Rheumatica