crystal arthropathies Flashcards
what is crystal arthritis
various crystlas deposited into joints so think its a foreign body causing severe pain and inflammation
types of crystals
gout
what is gout characterised by
uric acid- urate crystals
hyperuracaemia
what is pseudogout characterised by
calcium pyrophosphate cyrstals
what is gout
potentially disabling and erosive inflammatory arthritis caused by the deposition of monosodium urate crystals into joints and soft tissues
when might women get gout
after the menopause
which gender is more likely to get it
males
causes of hyperuricaemia
alcohol
high purine intake; red meat
diuretics
hypothyroidism
chronci renal impairement
fizzy drinks
what happens if gout is not treated
damage to joints
acute gout
very red and hot and swollen
settles in about 3 days with treatment
10 days without treatment
does a normal uric acid level rule out gout during acute episode
no
investigations for gout
serum uric acid
raised inflammatory markers
renal impairment
x-rays
exclude septic arthritis via synovial fluid
how to treat acute gout
nsaids
colchicine
steroids
if cant take nsaids what treatment is given for gout
colchicine/ steroids
how to ensure gout doesnt happen again
lifestyle modifications
if have repeated episodes of gout how is it treated
xanthine oxidase inhibitors- uric acid inhibitor
uricosuric drugs- increases excretion of uric acid ; sulfinpyrazone, probenecid, benzbromarone
indications for prophylactic therapy of gout
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.
most common affected joints in pseudogout
knees, wrists and ankles
who is pseduogout more common in
elderly
those with osteoarthritis
treatment of pseudogout
nsaids
colchicine
steroids
rehydration
what is soft tissue rhuematism caused by
inflammation and damage to structures around the joint
is soft tissue rheumatism localised
yes
most commno place for soft tissue pain
shoulder
treatment for soft tissue problems
Pain control
Rest and Ice compressions
PT
Steroid injections
Surgery
investigations for soft tissue problems
Clinical history and examination.
X-ray - calcific tendonitis
Ultrasound scans.
MRI if fails to settle.
Identify precipitating factors
definitive diagnosis for gout
joint aspiration
gout crystals v pseudogout crystals
rhomboid shaped and calcium for pseudogout whereas lone gout are made up of urate crystals and are needle-shaped and negatively birefringent
risk factors assoc specifically to pseudogout
hyperthyroidism and haemachromatosis
what does apple green birefringence suggest
amyloid protein
calcium pyrosphate
pseudo gout
weak posiitve birefringence- bigger and thicker than gout so rhomboid shaped
when is purine formed
in DNA replication as it is the end product of purine synthesis, adenine and guanine are purine based
causes of uric acid build up
making too much/ getting rid of too little
drug side effect causing gout
thiazides as reduce urate excretion
