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Musculoskeletal > Crystal Arthopathy > Flashcards

Crystal Arthopathy Flashcards

1
Q

What are crystal arthopathy diseases characterised by?

A

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

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2
Q

What are some common crystal arthopathy diseases?

A
  • Monosodium urate (gout)
  • Calcium pyrophosphate dehydrate (CPPD, also called pseudogout)
  • Basic calcium phosphate hydro-apatit (BCP, also called calcific periarthritis/tendonitis)
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3
Q

What crystals cause gout?

A

Monosodium urate

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4
Q

What crystals cause pseudogout?

A

Calcium pyrophosphate dehydrate

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5
Q

What crystals cause calcific periarthritis/tendonitis?

A

Basic calcium phosphate hydro-apatit

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6
Q

Where does most of the urate in the body come from?

A

2/3 of urate in body comes from breakdown of purines produced within body (breakdown of DNA and RNA), remainder comes from breakdown of purines in food and drinks

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7
Q

Where is most uric acid excreted?

A

70% of uric acid is excreted in kidney, and 30% in biliary tract

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8
Q

What can hyperuricaemia occur due to?

A

Hyperuricaemia can occur due to overproduction or under excretion:

  • Overproduction
    • Malignancy such as lymphoproliferative
  • Severe exfoliative psoriasis
  • Drugs
    • Such as ethanol, cytotoxic drugs
  • Inborn errors of metabolism
  • HGPRT deficiency
    • Known as Lesch Nyan syndrome
    • X-linked recessive
    • Intellectual disability, aggressive and impulsive behaviour, gout, renal disease
  • Under excretion (commonest cause)
    • Renal impairment
    • Hypertension
    • Hypothyroidism
    • Drugs
      • Such as alcohol, low dose aspirin, diuretics, cyclosporine
    • Exercise, starvation, dehydration
    • Lead poisoning
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9
Q

Is overproduction or underexcretion the more common cause of hyperuricaemia?

A

Under excretion

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10
Q

What are some causes of overproduction of uric acid?

A
  • Malignancy such as lymphoproliferative
  • Severe exfoliative psoriasis
  • Drugs
    • Such as ethanol, cytotoxic drugs
  • Inborn errors of metabolism
  • HGPRT deficiency
    • Known as Lesch Nyan syndrome
    • X-linked recessive
    • Intellectual disability, aggressive and impulsive behaviour, gout, renal disease
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11
Q

What are some causes of underexcretion of uric acid?

A
  • Renal impairment
  • Hypertension
  • Hypothyroidism
  • Drugs
    • Such as alcohol, low dose aspirin, diuretics, cyclosporine
  • Exercise, starvation, dehydration
  • Lead poisoning
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12
Q

Are more woman or men affected by gout?

A

M>F (as oestrogen helps excretion of uric acid in kidney)

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13
Q

What are some lifestyle risk factors for gout?

A
  • Diet high in meat/fish
  • Alcohol drinking
  • Lots of sports
  • Dehydration
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14
Q

What is the clinical presentation of gout?

A
  • Red
  • Hot
  • Erythema
  • Pain
  • Often the foot
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15
Q

What is the mangement of gout?

A
  • Acute flair
    • NSAIDs
    • Colchicine
    • Steroids
  • Long term
    • Think 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 year
    • Prophylactically prior to treating certain malignancies
    • Do not treat asymptomatic hyperuricaemia
  • Address cardiovascular and lifestyle risk factors
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16
Q

How can you prophylactically lower uric acid?

A
  • Xanthine oxidase inhibitor (first line)
    • Such as allopurinol
  • Or febuxostat
    • For those unable to tolerate allopurinol
    • Avoid in patients with cardiac history
  • Uricosuric agents
    • Such as sulphinpyrazone
  • Canakinumab
17
Q

What are the rules for lowering uric acid levels?

A
  • Wait for acute attack to settle before lowering urate levels
  • Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal as the above treatments could trigger flair
  • Then adjust allopurinol dose according to renal function, starting low and working up
18
Q

Where does gout most commonly affect?

A

Feet

19
Q

Where does pseudogout most commonly affect?

A

Knee

20
Q

Does pseudogout affect more males or females?

A

Usually affects older females, with erratic flares of joint swelling

21
Q

What is the aetiology of pseudogout?

A
  • Idiopathic
  • Familial
  • Metabolic
22
Q

What are some triggers of pseudogout?

A
  • Trauma
  • Intercurrent illness
23
Q

What are some clinical features of pseudogout?

A
  • Chondrocalcinosis (depositions of CPPD crystals into fibrous or hyaline cartilage) on x-ray
  • Can see pyrophosphate crystals on aspiration
24
Q

What is chondrocalcinosis?

A

(depositions of CPPD crystals into fibrous or hyaline cartilage)

25
Q

What is the mangement of pseudogout?

A
  • NSAIDs
  • I/A steroids
  • There are no prophylactic therapies
26
Q

What is polymyalgia rheumatica?

A

Inflammatory condition in elderly with close relation to giant cell arthritis

27
Q

Does polymyalgia rheumatica affect more males or females, and what age group?

A
  • F > M
  • Rare <50 years, usually >70 years
28
Q

What are clinical features of polymyalgia rheumatica?

A
  • Sudden onset of shoulder with or without pelvic girdle stiffness
  • Anaemia
  • Arthralgia
  • Systemic features
    • Malaise
    • Weight loss
    • Fever
    • Depression
29
Q

What is the differential diagnosis for polymyalgia rheumatica?

A
  • Myalgic onset inflammatory joint disease
  • Underlying malignancy
  • Inflammatory muscle disease
  • Hypo/hyperthyroidism
  • Bilateral shoulder capsulitis
  • Fibromyalgia
30
Q

What is the treatment for polymyalgia rheumatica?

A
  • Prednisolone 15mg per day initialy
    • 18-24 month course
  • Bone prophylaxis

Musculoskeletal (40 decks)

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