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MOHD4: Exam 5 > Crystal arthritis > Flashcards

Crystal arthritis Flashcards

1
Q

Pain and swelling in big toe

A

Podagra

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2
Q

Triggering events in gout attack

A

Trauma
Dietary/OH excess
Diuretic use/change

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3
Q

Risk of gout:

A

Age, family history, obesity, diabetes, HTN, OH use, acute illness, surgery

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4
Q

Calcium pyrophosphase (CPP) crystals are deposited in

A

articular cartilage

menisci, synovium, periarticular tissues

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5
Q

May be used to treat CHRONIC inflammatory CPPD

A

Hydroxychloroquine, Methotrexate if NSAIDs or Colchisine inadequate

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6
Q

Intercritical period in gout is

A

Asymptomatic periods

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7
Q

How likely is another acute attack in the first year after a first attack?

A

60%

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8
Q

Allopurinol side effects

A

Allopurinol hypersensitivity, NVD, marrow suppression, hepatitis, fever, vasculitis, alopecia

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9
Q

CPPD is associated with

A

aging, hyperparathyroidism, hemochromatosis, trauma, hypophos/hypomag

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10
Q

Asymptomatic hyperuricemia begins at

A

Puberty for men

Menopause for women

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11
Q

Clinical presentation of CPPD

A

Usually mostly asymptomatic

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12
Q

Asymptomatic hyperuricemia is associated with

A

hypertension, hyperglycemia, obesity, hyperlipidemia, CV disease

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13
Q

Tophi =

A

Aggregated MSU crystals

Usually located on ulnar surface of forearms, tendons, olecranon, ear, joints

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14
Q

Options for acute gout therapy

A

colchicine
NSAID
corticosteroids
joint injection if no infection

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15
Q

Febuxostate

A

non-competitive xanthine oxidase inhibitor

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16
Q

Joints affected by Acute Gout

A

MTP, instep, ankles, knees, prepaterllar/olecranon bursae

17
Q

Acute gout is usually ______articular

A

MONOarticular

18
Q

Allopurinal, Febuxostate are…

A

Xanthine oxidase inhibitors

Stop purine metabolism, uric acid doesn’t form

19
Q

It is possible for people in an acute attack to have a normal uric acid level

A

True - 50% will have normal level

20
Q

Acute CPP (pseudogout) presents with

A

acute/subacute arthritis for several days, monoarthritis (knees, wrists), podagra UNcommon, may follow surg/trauma/illness/diuresis

21
Q

Characteristic Radiology finding of Tophi/Chronic gout

A

Punched out erosions surrounded by radiodensity

Joint space preservation, normal mineralization

Late disease: punched out lesions with overhanging edges

22
Q

Chronic/tophaceous gout is usually _____articular

A

POLYarticular

23
Q

Side effects include cardiovascular (MI, CVA), elevated liver transaminases, gout flare

A

Febuxostat

24
Q

Chronic Kidney Disease is probably d/t

A

precipitation of uric acid crystals
hypertension
diabetes

Raising SUA induces glom HTN, fibrosis
Lowering SUA may slow CKD progression

25
Q

Presumptive Gout Diagnosis

A

Rapid, severe pain
Pain, erythema, swelling
Hyperuricemia

26
Q

Chronic Inflammatory CPPD presents as

A

polyarticular, symmetric arthritis of small joints in hands/feet

27
Q

What happens when phagocytes ingest crystals?

A

Lysis and inflammatory response

28
Q

mimics DJD

A

OA with CPP clinical presentation

29
Q

Risk for kidney stones is _______ to uric acid level (SUA)

A

proportional

30
Q

Colchicine

A

Inhibits microtubule formation (turn off cytokine cascade, inhibit NLRP3 assembly)

31
Q

What is released with macrophace lysis?

A

IL-1, IL-18, cytokines

Followed by neutrophil infiltration

32
Q

Management of Gout

A

Baseline: Ed, diet, lifestyle
Look for secondary hyperuricemia causes
Acute therapy (colchicine, NSAID, corticosteroids, joint injection if no infection)

33
Q

Diagnosis of CPPD

A 
Weakly birefringent, 
Positive birefringents (aligned blue calcium)
Rhomboid crystals, intracellular
34
Q

Things that can lead to hyperuricemia

A

High purine diet
Alcohol (beer highest)
Fructose
cell death

ATP -> AMP -> Uric acid

35
Q

XOI alternative

A

Probenecid

36
Q

Diagnosis of Gout

A

Demonstrate needle shaped crystal inside cell, Negatively birefringent, Parallel-yellow (plane of polarization)

(If the crystal is perpendicular to plane it will be blue)

37
Q

CPPD radiology features

A

Cartilage calcification (deposition into fibrous/hyaline calcium)
Uniform joint space loss
No erosions
Knees > Hands > Symphasis

38
Q

Uricosuric added to XOI if

A

XOI not tolerated, under 60, normal renal function, no history of stones, more than 2 attacks/year,

MOHD4: Exam 5 (23 decks)

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