Crystal Arthropathies Flashcards
What are the 2 types of crystal arthropathies?
Gout
Pseudogout
When a patient presents with an acutely swollen, red and hot joint, what are the differentials?
SEPTIC ARTHRITIS (MUST BE RULED OUT)
Gout
Pseudogout
RA flare
What is the pathophysiology of Gout?
High uric acid levels lead to deposition of mono sodium Urate crystals within the joint
What investigations would be done if a patient presents with an acutely hot, red and swollen joint?
FBC
Temp
Sats
BP
Serum Urate levels
Essentially trying to assess septic picture
Emergency joint aspirate if indicated
With a joint aspirate for a red, hot and swollen painful joint, what is being tested for?
MCS
+
Crystal investigations
Looking for infective process Vs crystal inflammatory process
How can gout present outside of joints (extra-articular)?
Gouty tophi
What are Gouty Tophi?
Subcutaneous depositions of uric acid
Often at hands, ears and elbows
What will the findings be on the joint aspirate for the crystal investigation for gout?
Negatively bi-refringent Needle shaped crystals
NN (negative and needle)
What joints does gout commonly affect?
1st metatarsophalangeal joint
1st Metacarpophalangeal joint
What is the alternate name for gout in the 1st metatarsophalangeal joint?
Podagra
How does a red hot painful swollen joint of gout compare to rheumatoid arthritis?
Gout = extremely acute in onset
RA = gradual onset
What are the risk factors for developing Gout?
Male
Obese
Obese
High purine diet (meats, seafood)
Diuretics (loops and thiazide)
Alcohol
Cardiovascular disease
Kidney disease
What imaging is useful to identify gout?
X-ray
What X-ray changes are seen with Gout?
MAINTAINED JOINT SPACE
Lytic lesions
Punched out lesions:
-have sclerotic borders
-overhanging edges.
What is the acute treatment for gout?
NSAIDs (naproxen) + Gastroprotection (omeprazole)
Colchicine (when NSAIDs contraindicated)
When is colchicine used over NSAIDs (since NSAIDs are first line) for managing acute gout?
NSAIDs contraindicated:
-peptic ulcer disease
-severe renal impairment
-heart failure
What medications do you give to treat chronic gout and what do they do?
Allopurinol 1st line
Febuxostat
Lower levels of uric acid
What lifestyle changes can a patient make to manage their Gout?
Weight loss
Hydration
Alcohol reduction
Reduced meats and purine concentrated foods
When is allopurinol or febuxostat given with. Gout?
Weeks after the acute attack has been managed
What are the crystals made out of in Pseudogout?
Calcium pyrophosphate crystals
What structure of crystals would appear on the joint aspirate for Pseudogout?
Positively birefringent rhomboid shaped crystals
P for Pseudo
What are the commonly affected joints for Pseudogout?
Knee
Shoulders
Hips
What is the classical x-ray finding for Pseudogout?
Chondrocalcinosis
LOSS picture
What is the management for Pseudogout?
NSAIDS + Gastroprotection
Colchine
Intra-articular steroid injections
Oral steroids
What are the lifestyle changes that a patient can make to reduce chances of having Pseudogout?
Nothing reduces risk
