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MSK > Crystal Arthopathy > Flashcards

Crystal Arthopathy Flashcards

1
Q

What is tophus?

A

Massive accumulation of uric acid

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2
Q

What are purines metabolised to?

A

Hypoxanthine, xanthine, plasma urate and then finally uric acid

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3
Q

What is uric acid the metabolic product of?

A

Purines

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4
Q

What may cause overproduction of uric acid?

A 
Malignancy
Severe exfoliative psoriasis
Ethanol
Cytotoxic drugs
Inborn metabolic errors
HGPRT deficiency
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5
Q

Why does alcohol result in hyperuricaemia?

A

Alcohol raises lactic acid level which inhibits uric acid secretion

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6
Q

What may cause under excretion of uric acid?

A 
Renal impairment
Hypertension
Hypothyroidism
Alcohol
Low dose aspirin
Diuretics
Cyclosporin
Exercise, starvation, dehydration
Lead poisoning
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7
Q

Deficiency in which enzyme is assoictaed with Lesch Nyan syndrome?

A

HGPRT

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8
Q

What are some common features of Lesch Nyan syndrome?

A 
Intellectual disability
Agressive
Impulsive
Self mutilation
Gout
Renal disease
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9
Q

How do we manage an acute flare of gout?

A

NSAIDs
Colchicine
Steroids

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10
Q

What is allopurinol?

A

Xanthine oxidase inhibitor

Used to lower uric acid

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11
Q

What are some general rules when 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

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12
Q

Where does pseudogout usually occur?

A

Knee

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13
Q

Which patient are most affected by pseudogout?

A

Elderly females

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14
Q

What may trigger pseudogout?

A

Trauma

Intercurrent illness

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15
Q

How is pseudogout managed?

A

NSAIDs

Steroids

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16
Q

Which other condition is closely associated with polymyalgia rheumatica?

A

GCA

Giant Cell Arteritis

17
Q

How does polymyalgia rheumatica present?

A 
Sudden onset shoulder and pelvic girdle stiffness
Older
More common with females
ESR >45
Anaemia
Depression
Arthralgia
18
Q

How is polymyalgia rheumatica diagnosed?

A

Age >50
ESR >50
Dramatic steroid response
There is no specific test

19
Q

What are some differential diagnoses with polymyalgia rheumatica?

A 
Myalgic onset inflammatory joint disease
Inflammatory muscle disease
Hypo/ hyperthyroidism
Bilateral shoulder capsulitis
Fibromyalgia
20
Q

How do we treat polymyalgia rheumatica?

A

Prednisolone 15mg per day

18-24 month course

MSK (26 decks)

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