Crystal Arthritis Flashcards
Dr K Vinod
what is gout?
inflammation in the joint triggered by uric acid crystals
what are the 2 causes of uric acid build up?
excess consumption
under excretion
name the 2 causes of hyperuricaemia
increased rate production
reduced urate excretion
what causes increased urate production?
inherited enzymes defects psoriasis alcohol haemolytic disorders high purine intake - red meat, seafood and corn syrup
what causes reduced urate excretion?
chronic renal impairment heart failure hypothyroidism diuretics cytotoxics
what is the mmol/l threshold in OA?
0.42 mmol/l
what sex is gout more common in?
male
who is gout very rare in?
women before menopause
what does acute gout most commonly affect?
1st MTP > ankle > knee
abrupt onset
overnight
how long is it till acute gout settles?
10 days without treatment
3 days with treatment
what drug is chronic tophaceous gout associated with?
diuretics
what is seen in chronic tophaceous gout?
high serum uric acid
top
explain the investigations and findings in gout
raised inflammatory markers
raised serum uric acid
polarising microscopy shows needle shaped crystals in synovial fluid
X-rays
name the treatment in acute gout
NSAIDs
Colchicine
steroids
name the prophylaxis in gout
allopurinol
febuxostat
start 2-4 weeks after acute attack
require cover with NSAID
what does calcium pyrophosphate deposition disease affect in body? and in who more commonly?
fibrocartilage of knees, wrists and ankles
elderly
what does chondrocalcinosis increase with?
age
name the 2 types of calcium pyrophosphate deposition disease
Calcium pyrophosphate (pseudogout)
Calcium hydroxy appatite crystals
what are acute attacks of calcium pyrophosphate deposition disease due to?
calcium pyrophosphate crystals (pseudogout)
what shape are calcium pyrophosphate crystals? (pseudogout)
rhomboid
name the treatment in calcium pyrophosphate deposition disease
NSAIDs
Colchicine
Steroids
rehydration
hydroxyapatite crystal deposition in or around the joint of the shoulder is also called what?
Milwaukee shoulder
what does hydroxyapatite in Milwaukee shoulder release?
collagenases
IL-1
Milwaukee shoulder has acute and rapid deterioration in females 50-60 years
true or false?
true
what is the treatment in Milwaukee shoulder?
NSAIDs
intra-articular steroid injection
physiotherapy
partial or total arthroplasty
