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Rhematology > Crystal Arthritis > Flashcards

Crystal Arthritis Flashcards

1
Q

What is crystal arthropathy?

A

Arthritis caused by crystal deposition in joint lining

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2
Q

What is crystal arthropathy?

A

Arthritis caused by crystal deposition in joint lining

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3
Q

What can the crystals be made from?

A
  • Urate
  • Calcium pyrophosphate
  • Hydroxapatite
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4
Q

What makes up the crystals in gout?

A

Monosodium urate

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5
Q

What do monosodium crystals look like?

A

Negative birefringent needles

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6
Q

How are the monosodium urate crystals formed in gout?

A
  • Purines are converted to uric acid via xanthine oxidase

- Uric acid is converted to monosodium urate

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7
Q

What is the normal serum level of urate?

A

0.3mm/L

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8
Q

What happens in the acute inflammation involved in a gout attack?

A
  • Urate crystals activate phagocytes and cause inflammation
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9
Q

How long can it take for tophi to resolve?

A

Up to 2 years

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10
Q

How long can it take for tophi to resolve?

A

Up to 2 years

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11
Q

What can the crystals be made from?

A
  • Urate
  • Calcium pyrophosphate
  • Hydroxapatite
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12
Q

What makes up the crystals in gout?

A

Monosodium urate

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13
Q

What do monosodium crystals look like?

A

Negative birefringent needles

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14
Q

When should you consider pseudogout might be metabolic disease?

A

If presentation is similar but seen in a younger person

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15
Q

What is the normal serum level of urate?

A

0.3mm/L

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16
Q

What happens in the acute inflammation involved in a gout attack?

A
  • Urate crystals activate phagocytes and cause inflammation
17
Q

What are Tophi?

A

They are seen in long term deposition and are onion like aggregates of urate crystals with inflammatory cells

18
Q

How long can it take for tophi to resolve?

A

Up to 2 years

19
Q

What are the crystals made of in pseudogout?

A

Calcium pyrophosphate crystals

20
Q

What joints usually present with pseudogout?

A

Knee > wrist > shoulder > ankle > elbow

21
Q

How is pseudogout usually discovered?

A

by accident in other xrays

22
Q

What things are likely to trigger an acute attack in pseudogout?

A
  • Direct trauma to the joint
  • Intercurrent illness
  • Surgery
  • Blood transfusion
23
Q

When should you consider pseudogout might be metabolic disease?

A

If presentation is similar but seen in a younger person

24
Q

How would you describe the crystals in pseudogout?

A

Rhomboid shaped and positive birefringent

25
Q

What is the long term treatment for gout?

A

Aim - urate <0.3mmol/L
Non pharma - lose weight etc.
Withdraw drugs e.g thiazides
Allopurionol! - xanthine oxidase inhibitor

26
Q

What is the presentation of gout?

A
  • Hot swollen joints
  • Common joints: 1st metatarsal of big toe -
  • Pain
  • May be polyarticular but typically monoarticular
27
Q

What is the presentation of psuedogout?

A
  • Normally monoarticular not poly
  • Severe pain
  • Stiffness
  • Swelling
  • Fever
  • Resolution in 1-3 weeks
28
Q

What is the presentation of metabolic disease?

A
  • Early onset <55
  • Polyarticular
  • Frequent recurrent attack
29
Q

Why would you aspirate the joint?

A

To rule out septic arthritis

30
Q

What would you see on the xray in gout?

A

B - Bony hooks
E - Erosions
T - Tophi
S - Space intact

31
Q

What would you see in the xray with pseudogout?

A

Chondrocalcinosis - linear calcification parallel to articular surfaces

32
Q

What would you see on the U&E for gout?

A
  • Might be normal in an acute attack

- Can be used to exclude a diagnosis if serum uric acid is in the lower half of normal range

33
Q

What is the acute treatment for gout?

A
  • NSAIDs
  • Colchicine
  • Corticosteriodss
34
Q

What is the long term treatment for gout?

A

Aim - urate <0.3mmol/L
Non pharma - lose weight etc.
Withdraw drugs e.g thiazides
Allopurionol! - xanthine oxidase inhibitor

35
Q

What is the treatment for psuedogout?

A

Similar to gout

acute = NSAIDs, aspiration of joint, injection of joint, physio

Rhematology (8 decks)

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