crystal arthropathies

Question 1

what is crystal arthritis

Answer 1

various crystlas deposited into joints so think its a foreign body causing severe pain and inflammation

Question 2

types of crystals

Answer 2

gout

Question 3

what is gout characterised by

Answer 3

uric acid- urate crystals
hyperuracaemia

Question 4

what is pseudogout characterised by

Answer 4

calcium pyrophosphate cyrstals

Question 5

what is gout

Answer 5

potentially disabling and erosive inflammatory arthritis caused by the deposition of monosodium urate crystals into joints and soft tissues

Question 6

when might women get gout

Answer 6

after the menopause

Question 7

which gender is more likely to get it

Answer 7

males

Question 8

causes of hyperuricaemia

Answer 8

alcohol
high purine intake; red meat
diuretics
hypothyroidism
chronci renal impairement
fizzy drinks

Question 9

what happens if gout is not treated

Answer 9

damage to joints

Question 10

acute gout

Answer 10

very red and hot and swollen
settles in about 3 days with treatment
10 days without treatment

Question 11

does a normal uric acid level rule out gout during acute episode

Answer 11

no

Question 12

investigations for gout

Answer 12

serum uric acid
raised inflammatory markers
renal impairment
x-rays
exclude septic arthritis via synovial fluid

Question 13

how to treat acute gout

Answer 13

nsaids
colchicine
steroids

Question 14

if cant take nsaids what treatment is given for gout

Answer 14

colchicine/ steroids

Question 15

how to ensure gout doesnt happen again

Answer 15

lifestyle modifications

Question 16

if have repeated episodes of gout how is it treated

Answer 16

xanthine oxidase inhibitors- uric acid inhibitor
uricosuric drugs- increases excretion of uric acid ; sulfinpyrazone, probenecid, benzbromarone

Question 17

indications for prophylactic therapy of gout

Answer 17

1) One or more attacks of gout in a year inspite of lifestyle modification.
2) Presence of gouty tophi or signs of chronic gouty arthritis.
3) Uric acid calculi.
4)Chronic renal impairment.
5)Heart failure where unable to stop diuretics.
6)Chemotherapy patients who develop gout.

Question 18

most common affected joints in pseudogout

Answer 18

knees, wrists and ankles

Question 19

who is pseduogout more common in

Answer 19

elderly
those with osteoarthritis

Question 20

treatment of pseudogout

Answer 20

nsaids
colchicine
steroids
rehydration

Question 21

what is soft tissue rhuematism caused by

Answer 21

inflammation and damage to structures around the joint

Question 22

is soft tissue rheumatism localised

Answer 22

yes

Question 23

most commno place for soft tissue pain

Answer 23

shoulder

Question 24

treatment for soft tissue problems

Answer 24

Pain control
Rest and Ice compressions
PT
Steroid injections
Surgery

Question 25

investigations for soft tissue problems

Answer 25

Clinical history and examination.
X-ray - calcific tendonitis
Ultrasound scans.
MRI if fails to settle.
Identify precipitating factors

Question 26

definitive diagnosis for gout

Answer 26

joint aspiration

Question 27

gout crystals v pseudogout crystals

Answer 27

rhomboid shaped and calcium for pseudogout whereas lone gout are made up of urate crystals and are needle-shaped and negatively birefringent

Question 28

risk factors assoc specifically to pseudogout

Answer 28

hyperthyroidism and haemachromatosis

Question 29

what does apple green birefringence suggest

Answer 29

amyloid protein

Question 30

calcium pyrosphate

Answer 30

pseudo gout
weak posiitve birefringence- bigger and thicker than gout so rhomboid shaped

Question 31

when is purine formed

Answer 31

in DNA replication as it is the end product of purine synthesis, adenine and guanine are purine based

Question 32

causes of uric acid build up

Answer 32

making too much/ getting rid of too little

Question 33

drug side effect causing gout

Answer 33

thiazides as reduce urate excretion