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LOCO2 > Crystal Arthropathies > Flashcards

Crystal Arthropathies Flashcards

1
Q

Gout is a disorder of what metabolism

A

Uric acid metabolism

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2
Q

What causes gout

A

Deposition of mono sodium rate crystals in soft tissues due to disordered uric acid metabolism

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3
Q

What triggers a gout attack

A

Uncoated mono sodium rate crystals or sudden large change in crystal concentration

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4
Q

Are monosodium irate crystals inert or active when coated with serum proteins

A

Inert

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5
Q

Cycle of gout attack

A

Attack starts -> crystals form -> WBC attack -> cell popped by crystals -> proteins released -> further inflammation + pain -> proteins decr pH allowing more crystals to form

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6
Q

Is gout usually mono or polyarticular

A

Monoarticular

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7
Q

Podagra

A

Gout affecting 1st MTP joint in big toe

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8
Q

Most common joints effected by gout

A

1st MTP
other small lower extremity joints

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9
Q

How does a gout attack begin

A

Suddenly
Max intensity in 8-12hrs

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10
Q

Are men or women affected by gout more

A

Men

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11
Q

Characteristics of gout affected joint

A

Red
Hot
Exquisitely tender
Pain starts acutely usually at night

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12
Q

Why do untreated 1st attacks resolve spontaneously in less than 2 weeks

A

Crystals get coated by serum proteins or phagocytosed

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13
Q

How does gout progress over time

A

Attacks get closer,more painful, and last longer
Attacks eventually become continuous
Becomes polyarticular
Can affect other synovial structures

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14
Q

Gouty tophi

A

Nodular masses of monosodium urate crystals in soft tissues

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15
Q

What cells surround ms urate crystals in tophi

A

Lymphocytes
Macrophages
Foreign body giant cells

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16
Q

Uric acid is an end stage by product of which metabolism

A

Purine metabolism

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17
Q

How is Uric acid removed

A

Urine
Faeces

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18
Q

What serum urate level is saturation

A

6.8mg/dL

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19
Q

What is high serum urate called

A

Hyperuricemia

20
Q

Gout risk factors

A

Foods high in purines
Under excretion of Uric acid - renal insufficiency, dehydration, diuretics

21
Q

How many characteristics on the gout criteria are needed for a probable gout diagnosis

A

6+

22
Q

What is needed for a definitive gout diagnosis

A

Urate crystals in joint fluid during attack and joint fluid culture negative for organisms during attack

23
Q

Gout synovial fluid characteristics

A

Inflammatory
High WBCs
Polymorphonuclear neutrophils
Urate crystals

24
Q

What level of hyperuricemia requires treatment

A

11mg/dL+

25
Q

How does gout effect joint space

A

No effect

26
Q

Gout characteristics on XR and ultrasound

A

Soft tissue swelling
Incr blood flow
Erosion outside joint capsule
Rate bite erosions

27
Q

What imaging type can detect and measure Uric acid crystals

A

Dual energy computed tomography DECT

28
Q

How can tophi lead to bone erosion

A

Produce pro inflammatory cytokines which stimulate osteoclasts via RANKL

29
Q

Acute gout attack treatment

A

NSAIDS
Colchicine - used less now
Corticosteroids
IL1 biologicals - rilonacept canakinumab anakinra

30
Q

How long should NSAID dose be changed during and after a gout attack

A

High for 2-3 days
Taper over 2 wks
Keep taking until symptoms absent for 2 days

31
Q

Why is colchicine used less for gout now

A

Narrow therapeutic window
Toxicity risk

32
Q

Colchicine MOA

A

Blocks mitosis by preventing Tubulin polymerisation decreasing neutrophil numbers

33
Q

Why is coffee mildly protective against gout

A

Increase urate excretion

34
Q

Chronic gout treatment

A

Decr Uric acid level
Allopurinol
Probenecid
Rasburicase

35
Q

Allopurinol MOA

A

Inhibits Xanthine oxidase -> decr Uric acid generation

36
Q

Probenecid MOA

A

Incr uric acid excretion

37
Q

Rasburicase MOA

A

catalyses conversion of uric acid to allantoin

38
Q

What is calcium pyrophosphate deposition disease also known as

A

Pseudogout

39
Q

Calcium pyrophosphate deposition disease

A

Acute deposition of calcium pyrophosphate crystals in and around joints due to excess Ca and PO4

40
Q

Pseudogout/CPDD symptoms

A

Pseudo OA symptoms or asymptomatic

41
Q

Pseudogout/CPDD X-ray findings

A

Osteophytes
Soft tissue calcification
Chondrocalcinosis

42
Q

What causes joint inflammation in Pseudogout/CPPD

A

Release of CPDD crystals into joint space -> phagocytosis of crystals -> cytokine release -> inflammation

43
Q

What triggers acute Pseudogout/CPDD attacks

A

Trauma
Rapid serum ca conc decr

44
Q

Gout crystal shape and charge

A

Negative charge
Needle shape

45
Q

CPDD crystal charge and shape

A

Positive charge
Rhomboid shape

46
Q

Pseudogout/CPDD treatment’s

A

Intra articular corticosteroids
NSAIDs

47
Q

What condition can rarely have cholesterol and lipid crystals in the synovial fluid

A

RA

LOCO2 (26 decks)

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