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Musculoskeletal > Crystal Arthritis > Flashcards

Crystal Arthritis Flashcards

1
Q

what is gout?

A

inflammation in the joint triggered by uric acid crystals

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2
Q

which sex is gout more common in

A

men

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3
Q

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

A
  • inherited enzyme defects
  • myeloproliferative/lymphoproliferative disorders
  • psoriasis
  • haemolytic disorders
  • alcohol
  • high dietary during intake
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4
Q

what kinds of food contain purine?

A

red meat
seafood
corn syrup

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5
Q

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

A

beer & spirits

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6
Q

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

A
  • chronic renal impairment
  • volume depletion e.g. heart failure
  • hypothryoidism
  • diuretics
  • cytotoxics e.g. cyclosporin
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7
Q

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

A

monoarthropathy

  • MTP
  • ankle
  • knee
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8
Q

describe the onset of acute gout

A

abrupt, often over night

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9
Q

what is chronic tophaceous gout?

A

chronic joint inflammation with high serum uric acid & tophi

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10
Q

what is chronic tophaceous gout often associated with

A

diuretics

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11
Q

tophi

A

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

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12
Q

what investigations should be done for gout?

A 
serum uric acid - normal or raised
inflammatory markers = raised
polarised microscopy of synovial fluid
look for renal impairment 
xrays
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13
Q

what is the treatment of acute gout?

A

NSAIDs
Colchicine
Steroids

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14
Q

what is the prophylactic treatment of gout?

A

Allopurinol

Febuxostat

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15
Q

when should you start prophylactic treatment?

A

2-4 weeks after the first acute attack

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16
Q

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

A

elderly

chonedrocalcinosis increases with age

17
Q

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

A

OA

18
Q

where does calcium pyrophosphate deposition disease (CPPD) affect?

A

affects fibrocartilage:
knees
wrists
ankles

19
Q

what are acute attacks of CPPD due to?

A

calcium pyrophosphate crystals

20
Q

what do calcium pyrophosphate crystals look lie?

A

envelope shaped, mildly postively birefringent

21
Q

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

A

marked rise

22
Q

what is the treatment of CPPD?

A

NSAIDs
Colchicine
Steroids
Rehydration

23
Q

what is hyrdroxyapatite

A

hydroxyapatite cyrstal deposition in or around the joint

24
Q

milwaukee shoulder

A

hydroxyapatite

25
Q

what is released in hydroxyapatite?

A

collagenases
serine proteinases
IL1

26
Q

describe the onset of hydroxyapatite & its progression

A

acute

rapid deterioration

27
Q

in which demographic group is hydroxyapatite commonly found?

A

females

50-60 yrs old

28
Q

what is the treatment of hydroxyapatite?

A

NSAIDs
Intra-acrticular steroid injection
physiotherapy
partial or total arthroplasty

29
Q

what is soft tissue rheumatism?

A

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

30
Q

soft tissue rheumatism in the neck

A

muscular
usually self limiting
consider OA of spine & occipital migraine

31
Q

soft tissue rheumatism of the shoulder

A 
commonest area for soft tissue pain 
e.g. Adhesive Capsulitis
Rotator cuff tendinosis
Calcific tendonitis
Impingement
32
Q

investigations of soft tissue rheumatism

A

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

33
Q

treatment of soft tissue rheumatism

A 
pain control 
rest & ice 
physiotherapy
steroid injections 
surgery
34
Q

in which sex is joint hypermobility more common?

A

females

35
Q

what scoring system can be used to diagnose joint hypermobility?

A

Beighton Score

36
Q

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

A

hypermobile

37
Q

what is the treatment of hypermobility?

A

physiotherapy

explanation

38
Q

what would hypermobility likely present with?

A

arthralgia & premature OA

Musculoskeletal (22 decks)

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