Crystal Arthopathy Flashcards
crystals of monosodium urate is what disease
gout
crystals of calcium pyrophosphate dihydrate is what disease
pseudogout
presentation of gout
an acute gouty attack
- podagra = severe pain in first MTP of big toe
- severe pain in knee, wrist, shoulder, ankle etc
- tophi on joints
what is a gout tophi
an accumulation of monosodium urate crystals
risk factors for gout
seafood, red meat, alcohol and fizzy juice obesity smoking high blood pressure old male
what event in a woman’s life makes her uric acid begin to rise
menopause
3 investigations in gout
synovial fluid or tophi sample
24 hour urine sample
x-ray
when do you treat hyperuricaemia
if its the 2nd attack renal insufficiency urate calculi tophi polyarticular gout once the acute attack of gout has settles
which gout treating drug do you need to adjust for renal function
allopurinol
treatment of acute gouty attack
NSAIDs and colchine
consider IA corticosteroids
canakinumab if no better in 2-3 days
how does colchine work
inhibits WBC migration to site and hence reduced painful inflammation
pathophysiology of hyperuraemia and subsequent gout
uric acid comes from the breakdown of purines –> not very soluble –> at pH 7.4 is become urate ion –> bonds to monosodium –> monosodium urate crystal –> accumulates in areas of slow blood flow (renal tubules and joints) –> gout and kidney stones
causes of overproduction of uric acid
lymphoproliferative disorder
HGPRT deficiency
alcohol
causes of under excretion of uric acid
renal impairment hypertension hypothyroidism alcohol exercise starvation dehydration lead poisoning
cause of the majority of hyperuricaemia in gout
renal insufficiency
what condition is an X-linked disorder with HGPRT deficiency
Lesch Nyan Syndrome
treatment of uric acid
treat underlying cause allopurinol febuoxostat uricosuric agents canakinumab
crystals in pseudogout
calcium pyrophophate dihydrate (CPPD)
type of person likely to get pseudogout
eldery females
what joint is most affected by pseudogout
knee
what can be found in aspirated joint fluid from pseudogout
raised neutrophils and phosphate crystals
managment of pseudogout
NSAIDs
intra-articular steroid
what is bifringenment
reflectiveness of synovial fluid sample
+ve on pseudogout
-ve in gout
can be diagnostic
true/false there is no prophylaxis available for pseudogout
true - just gotta manage it as it comes and address lifestyle factors?
