Crystal Arthritis Flashcards
what is gout?
inflammation in the joint triggered by uric acid crystals
which sex is gout more common in
men
name some causes of hyperuricaemia that would have increased the production of uric acid crystals
- inherited enzyme defects
- myeloproliferative/lymphoproliferative disorders
- psoriasis
- haemolytic disorders
- alcohol
- high dietary during intake
what kinds of food contain purine?
red meat
seafood
corn syrup
what kinds of alcohol can cause an increased rate of production of uric acid?
beer & spirits
name some causes of hyperuricaemia that would reduce the rate of excretion of uric acid crystals
- chronic renal impairment
- volume depletion e.g. heart failure
- hypothryoidism
- diuretics
- cytotoxics e.g. cyclosporin
in order of likelihood, name the sites gout can be found
monoarthropathy
- MTP
- ankle
- knee
describe the onset of acute gout
abrupt, often over night
what is chronic tophaceous gout?
chronic joint inflammation with high serum uric acid & tophi
what is chronic tophaceous gout often associated with
diuretics
tophi
deposits of crystalline uric acid and other substances at the surface of joints or in skin or cartilage
what investigations should be done for gout?
serum uric acid - normal or raised inflammatory markers = raised polarised microscopy of synovial fluid look for renal impairment xrays
what is the treatment of acute gout?
NSAIDs
Colchicine
Steroids
what is the prophylactic treatment of gout?
Allopurinol
Febuxostat
when should you start prophylactic treatment?
2-4 weeks after the first acute attack
in which age group is calcium pyrophosphate deposition disease (CPPD) commonest
elderly
chonedrocalcinosis increases with age
to which arthritis is calcium pyrophosphate deposition disease (CPPD) related?
OA
where does calcium pyrophosphate deposition disease (CPPD) affect?
affects fibrocartilage:
knees
wrists
ankles
what are acute attacks of CPPD due to?
calcium pyrophosphate crystals
what do calcium pyrophosphate crystals look lie?
envelope shaped, mildly postively birefringent
what would you expect to happen to inflammatory markers in acute CPPD attacks
marked rise
what is the treatment of CPPD?
NSAIDs
Colchicine
Steroids
Rehydration
what is hyrdroxyapatite
hydroxyapatite cyrstal deposition in or around the joint
milwaukee shoulder
hydroxyapatite
what is released in hydroxyapatite?
collagenases
serine proteinases
IL1
describe the onset of hydroxyapatite & its progression
acute
rapid deterioration
in which demographic group is hydroxyapatite commonly found?
females
50-60 yrs old
what is the treatment of hydroxyapatite?
NSAIDs
Intra-acrticular steroid injection
physiotherapy
partial or total arthroplasty
what is soft tissue rheumatism?
general term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerves near a joint rather than the bone or cartilage
soft tissue rheumatism in the neck
muscular
usually self limiting
consider OA of spine & occipital migraine
soft tissue rheumatism of the shoulder
commonest area for soft tissue pain e.g. Adhesive Capsulitis Rotator cuff tendinosis Calcific tendonitis Impingement
investigations of soft tissue rheumatism
usually unnecessary
x-ray - calcific tendonitis
MRI if fails to settle
treatment of soft tissue rheumatism
pain control rest & ice physiotherapy steroid injections surgery
in which sex is joint hypermobility more common?
females
what scoring system can be used to diagnose joint hypermobility?
Beighton Score
what would a brighten score of > 4/9 mean?
hypermobile
what is the treatment of hypermobility?
physiotherapy
explanation
what would hypermobility likely present with?
arthralgia & premature OA
