crystal arthropathies Flashcards
what causes gout?
excessive consumption or under production of purines
what is gout?
erosive inflammatory arthritis caused by deposition of monosodium urate crystals into joint and soft tissues
what are some causes of hyperuricaemia (inc urate production)?
myeloproliferative disorders
psoriasis
alcohol
high dietary purine intake (red meat, seafood, corn syrup)
what are some causes of hyperuricaemia (reduced urate excretion)?
chronic renal impairment
volume depletion e.g HF
hypothyroidism
diuretics
cytotoxics
where does acute gout usually affect?
1st MTP
ankle
knee
what is chronic gout often associated with?
diuretics
what will be seen on examination in gout?
high uric acid
tophi
what is diagnostic of gout?
inflammation of 1st MTP
what must you do in inflammation of the knee?
aspirate -> need to rule out septic arthritis
what will be seen in microscopy of gout?
negatively birefringent crystals
what is the management of gout?
NSAIDs
cochine
allopurinol (prophylaxis)
what is pseudogout related to?
osteoarthritis
where does pseudogout affect?
knees
wrists
ankles
what are acute attacks of pseudogout due to?
calcium pyrophosphate crystals
what will inflammatory marker be in pseudogout?
raised
what is seen in microscopy of pseudogout?
envelope shaped positively birefringent crystals
what is the management of pseuogout?
NSAIDs
colchine
steroids
what is calcium hydroxyapatite?
crystal deposition in or around joint
what does calcium hydroxyapatite release?
collagenases
serine proteinases
IL-1
what does calcium hydroxyapatite cause?
milwaukee shoulder
what is the management of calcium hydroxyapatite?
NSAIDs
IA steroids
what is soft tissue rheumatism?
pain caused by inflammation/damage to ligaments, tendons, muscles or nerves near a joint
what is the pain in soft tissue rheumatism described as being?
confined to specific site
what do we consider for more generalised soft tissue pain?
fibromyalgia
where is the most commonly affected area in soft tissue rheumatism?
shoulder
rotator cuff etc
