Crystal Arthritis

Question 1

what is gout?

Answer 1

inflammation in the joint triggered by uric acid crystals

Question 2

which sex is gout more common in

Answer 2

men

Question 3

name some causes of hyperuricaemia that would have increased the production of uric acid crystals

Answer 3

• inherited enzyme defects
• myeloproliferative/lymphoproliferative disorders
• psoriasis
• haemolytic disorders
• alcohol
• high dietary during intake

Question 4

what kinds of food contain purine?

Answer 4

red meat
seafood
corn syrup

Question 5

what kinds of alcohol can cause an increased rate of production of uric acid?

Answer 5

beer & spirits

Question 6

name some causes of hyperuricaemia that would reduce the rate of excretion of uric acid crystals

Answer 6

• chronic renal impairment
• volume depletion e.g. heart failure
• hypothryoidism
• diuretics
• cytotoxics e.g. cyclosporin

Question 7

in order of likelihood, name the sites gout can be found

Answer 7

monoarthropathy

• MTP
• ankle
• knee

Question 8

describe the onset of acute gout

Answer 8

abrupt, often over night

Question 9

what is chronic tophaceous gout?

Answer 9

chronic joint inflammation with high serum uric acid & tophi

Question 10

what is chronic tophaceous gout often associated with

Answer 10

diuretics

Question 11

tophi

Answer 11

deposits of crystalline uric acid and other substances at the surface of joints or in skin or cartilage

Question 12

what investigations should be done for gout?

Answer 12

serum uric acid - normal or raised
inflammatory markers = raised
polarised microscopy of synovial fluid
look for renal impairment 
xrays

Question 13

what is the treatment of acute gout?

Answer 13

NSAIDs
Colchicine
Steroids

Question 14

what is the prophylactic treatment of gout?

Answer 14

Allopurinol

Febuxostat

Question 15

when should you start prophylactic treatment?

Answer 15

2-4 weeks after the first acute attack

Question 16

in which age group is calcium pyrophosphate deposition disease (CPPD) commonest

Answer 16

elderly

chonedrocalcinosis increases with age

Question 17

to which arthritis is calcium pyrophosphate deposition disease (CPPD) related?

Answer 17

OA

Question 18

where does calcium pyrophosphate deposition disease (CPPD) affect?

Answer 18

affects fibrocartilage:
knees
wrists
ankles

Question 19

what are acute attacks of CPPD due to?

Answer 19

calcium pyrophosphate crystals

Question 20

what do calcium pyrophosphate crystals look lie?

Answer 20

envelope shaped, mildly postively birefringent

Question 21

what would you expect to happen to inflammatory markers in acute CPPD attacks

Answer 21

marked rise

Question 22

what is the treatment of CPPD?

Answer 22

NSAIDs
Colchicine
Steroids
Rehydration

Question 23

what is hyrdroxyapatite

Answer 23

hydroxyapatite cyrstal deposition in or around the joint

Question 24

milwaukee shoulder

Answer 24

hydroxyapatite

Question 25

what is released in hydroxyapatite?

Answer 25

collagenases serine proteinases IL1

Question 26

describe the onset of hydroxyapatite & its progression

Answer 26

acute | rapid deterioration

Question 27

in which demographic group is hydroxyapatite commonly found?

Answer 27

females | 50-60 yrs old

Question 28

what is the treatment of hydroxyapatite?

Answer 28

NSAIDs Intra-acrticular steroid injection physiotherapy partial or total arthroplasty

Question 29

what is soft tissue rheumatism?

Answer 29

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

Question 30

soft tissue rheumatism in the neck

Answer 30

muscular usually self limiting consider OA of spine & occipital migraine

Question 31

soft tissue rheumatism of the shoulder

Answer 31

``` commonest area for soft tissue pain e.g. Adhesive Capsulitis Rotator cuff tendinosis Calcific tendonitis Impingement ```

Question 32

investigations of soft tissue rheumatism

Answer 32

usually unnecessary x-ray - calcific tendonitis MRI if fails to settle

Question 33

treatment of soft tissue rheumatism

Answer 33

``` pain control rest & ice physiotherapy steroid injections surgery ```

Question 34

in which sex is joint hypermobility more common?

Answer 34

females

Question 35

what scoring system can be used to diagnose joint hypermobility?

Answer 35

Beighton Score

Question 36

what would a brighten score of > 4/9 mean?

Answer 36

hypermobile

Question 37

what is the treatment of hypermobility?

Answer 37

physiotherapy | explanation

Question 38

what would hypermobility likely present with?

Answer 38

arthralgia & premature OA