Crystal Arthropathies Flashcards
Epidemiology of Gout
Old age.
Comorbidities - renal failure, age, obesity
Women after menopause - due to loss of uricosuric affect of oestrogen.
Men over 40.
Risk factors of Gout
Thiazide diuretics
Cyclosporine
High purine diet
Alcohol
Pathology of gout
Monosodium urate crystals deposited in joints due to overproduction of Uric acid.
90% due to under-excretion
Which joint does gout most commonly effect
MTP (great toe )
Symptoms of gout
Hot, Swollen joint
Erythema
Fever
Extreme Pain
What investigation would you do for gout?
FBC
U&E
CRP
uric acid - 4 weeks after acute attack
Synovial fluid aspiration
X-ray
What would you see in a synovial fluid aspiration for gout?
Negatively birefringent needle shaped crystals under polarised light
What would see on an x ray of someone with gout?
Well defined erosions with sclerotic borders and overhanging edges
Rat bite erosions
No osteoporosis
What is the lifestyle management for gout?
Low purine diet
Low alcohol
Reduce weight
Increase fluids
What are the culprit medications of gout?
Thiazides
Furesmide
Cyclosporine
What is the acute management of gout ?
Rest
NSAIDs + PPI
colchicine
Prednisolone (steroid injection)
What is the management for chronic gout?
Allopurinol
Febuxostat
What is the mechanism of allopurinol?
Xanthine oxidase inhibitor
What is the epidemiology of pseudogout?
Elderly women - often asymptomatic
Less common than gout
Affects females more
What is the pathology of pseudogout ?
CPPD (calcium pyrophosphate crystals) deposited in cartilage, synovial, joint capsule and tendons.
Associated with haemochromatosis
Asymptomatic chondrocalcinosis - accelerates OA
