Crystal Arthropathies

Question 1

what causes Gout

Answer 1

deposition of urate crystals in a joint

Question 2

what causes urate crystal deposition in joints

Answer 2

high serum uric acid levels (hyperuricaemia)

Question 3

what is uric acid the final compound of

Answer 3

breakdown of purines in DNA metabolism (adenine and guanine)

Question 4

what can cause hyperuricaemia

Answer 4

renal underexcretion or excessive intake of alcohol, red meat and seafood

Question 5

what can cause renal underexcretion

Answer 5

diuretics or renal failure

Question 6

what can trigger uric crystal precipitation in joints

Answer 6

dehydration, trauma or surgery

Question 7

what is the common location for gout

Answer 7

first MTP joint (podagra), ankle to knee

Question 8

how does gout present

Answer 8

intensely painful, red, hot and swollen joint

Question 9

what is an important differential for gout

Answer 9

septic arthritis

Question 10

how long does it usually take for symptoms to die down if gout is untreated

Answer 10

7-10 days

Question 11

what are gouty tophi

Answer 11

painless white accumulations of uric acid occurring in the soft tissues and can erupt through the skin

Question 12

what can chronic gout cause

Answer 12

destructive erosive arthritis

Question 13

how is a definitive diagnosis made

Answer 13

analysing a sample of synovial fluid with polarised microscopy (also gram stain and culture to rule out infection)

Question 14

how do uric acid crystals show

Answer 14

needle shaped and negative birefringement (change from yellow to blue when lined across the direction of polarisation)

Question 15

what is the treatment for acute attacks

Answer 15

NSAID’s, corticosteroids, opioid analgesics and colchicine if patients can’t tolerate NSAID’s

Question 16

what is the treatment for recurrent attacks or gouty tophi

Answer 16

allopurinol or other urate lowering therapies (should not be started until an acute flare has settled or can cause further flare)

Question 17

what crystals cause pseudogout

Answer 17

calcium pyrophosphate crystals

Question 18

what is the term chondrocalcinosis used

Answer 18

when calcium pyrophosphate deposition occurs in cartilage and other soft tissues in the absence of inflammation

Question 19

what category do both pseudogout and chondrocalcinosis come under

Answer 19

calcium pyrophosphate deposition disease (CPPD)

Question 20

where does CPPD tend to affect

Answer 20

knee, wrist and ankle

Question 21

what conditions can CPPD occur with

Answer 21

hyperparathyroidism, hypothyroidism, renal osteodystrophy, haemochromatosis and Wilson’s disease and OA sometimes

Question 22

what can CPPD lead to

Answer 22

osteoarthritis change

Question 23

what is the treatment for acute CPPD

Answer 23

NSAID’s, corticosteroids (systemic and extra-articular) and colchicine

Question 24

are there any medications to prevent recurrence of CPPD

Answer 24

no