Crystal arthritis

Question 1

What crystal causes gout

Answer 1

Monosodium urate/uric acid

Question 2

What crystal causes pseudogout

Answer 2

Calcium pyrophosphate dihydrate

Question 3

What causes gout?

Answer 3

Over-production of uric acid, or underexcretion (abnormal renal handling). Can be a combination of both.

Question 4

What is uric acid a product of

Answer 4

Breakdown of purine bases

Question 5

What can cause overproduction of uric acid

Answer 5

Excess dietary purines (ie proteins, shellfish, red meats) alcohol abuse, myeloproliferative disorder, and lymphoproliferative disorder

Question 6

What can cause underexcretion of uric acid

Answer 6

Renal disease, polycystic kidney disease

Question 7

Who is gout most common in?

Answer 7

Men over 40, and post-menopausal women. Especially prevalent in patients with comorbidities

Question 8

Name predisposing factors for gout

Answer 8

Immediate post-op
Myocardial infaction
Stroke
Fasting
Alohol abuse
High purine intake
Local infection

Question 9

How can acute gout present?

Answer 9

Extreme pain, joint swelling, shiny skin, redness and warmth. Usually one joint but can be multiple.

Question 10

What joints are most commonly affected by acute gout

Answer 10

1st MTPJ most common, but can be ankles, knees, wrists and hands.

Question 11

Do acute gout attacks end by themselves

Answer 11

yes

Question 12

What is chronic gout

Answer 12

Occurs when patients have longstanding hyperuricemia with many gouty flares. May see neuropathy, uric acid stones in urinary tract\

Question 13

how should synovial fluid be analysed?

Answer 13

Aspiration of symptomatic joint, examined under a microscope in polarised light. Gram stain and culture to rule out infection.

Question 14

What will blood tests yield?

Answer 14

Usually raised serum uric acid but can appear normal. + ESR, CRP, WCC

Question 15

What will the joint fluid analysis show if the patient has gout

Answer 15

WCC present, culture if infection present.

URIC ACID RAISED> looks like little blue needles.

Question 16

What are the four aspects of patient management

Answer 16

Education, low purine diet, reduced alcohol and weight reduction

Question 17

How can acute gout attacks be treated?

Answer 17

Rest and ice, NSAIDs or COX II inhibitors, oral steroids, local steroid injection, oral colcicine.

Question 18

How can intercritical gout be treated?

Answer 18

DIet, alcohol, colcicine prophylaxis, urate lowering drugs (allopurinol) . COnsidered intercritical if 2+ attacks per year.

Question 19

How does allopurinol work

Answer 19

It is a xanthine oxidase inhibitor

Question 20

WHat are predisposing factors for pseudogout?

Answer 20

Hypothyroidism, hyperparathyroidism, haemachromatosis, acromegaly and gout

Question 21

What is the prevalence of pseudogout?

Answer 21

Much less common than gout, but more common in the elderly.

Question 22

What is the proper name for pseudogout?

Answer 22

Calcium pyrophosphate disease (CPPD). Pseudogout refers to acute synovitis within this

Question 23

What are the two types of CPPD

Answer 23

Acute synovitis, experiencing pain, swelling, stiffness.

Chronic pyrophosphate arthropathy (gradual onset of pai, akin to osteoarthritis)

Can also involve asymptomatic chondrocalcinosis

Question 24

What does synovial fluid analysis of CPPD show

Answer 24

Under polarised light examination, the CPPD crystals show as small rhomboid/rod shaped crystals. Examination should include gram stain and culture to rule out infection

Question 25

What are the radiographic anomalies of CPPD

Answer 25

Changes in osteoarthritis and associated with chondrocalcinosis

Question 26

how is pseudogout treated

Answer 26

Analgesia, joint aspiration, joint injection with steroids anf colcicine. No prophyaxis, but lifestyle advice includes weight loss, physio, pain control, or maybe joint replacement.