Crystal Arthropathies

Question 1

Gout is an inflammatory / non-inflammatory condition associated with ______

Answer 1

Inflammatory. Urate crystals

Question 2

Gout is more common in which sex?

Answer 2

Men

Question 3

What’s the most common inflammatory arthritis in men?

Answer 3

Gout

Question 4

Gout is how much more common than RA?

Answer 4

10x

Question 5

Hyperuricaemia is a serum uric acid greater than what mg/dL?

Answer 5

> 7mg/dL

Question 6

Risk of developing gout is proportional to degree of hyperuricaemia. True/false?

Answer 6

True

Question 7

Which 2 genetic conditions can result in over-production of uric acid?

Answer 7

• Lesch-Nyhan Syndrome

- Von Gierke Disease

Question 8

Psoriasis can predispose to gout. True/false?

Answer 8

True

Question 9

Which drugs can cause gout? (4)

Answer 9

1) Diuretics (thiazides)
2) Levodopa
3) Cyclosporin A
4) Pyrazinamide

Question 10

Which foods are rich in purines? (4)

Answer 10

• Red meat
• Offal
• Shellfish
• Legumes

Question 11

Gout generally affects which joint?

Answer 11

1st MTP

Question 12

Differential diagnoses for gout include (3)

Answer 12

1) Septic arthritis
2) Trauma
3) Seronegative arthritis (e.g. psoriatic, Reiter’s)

Question 13

Cutaneous deposition of uric acid leads to which sign?

Answer 13

Tophi

Question 14

Inflammatory markers are raised in gout. True/false?

Answer 14

True

Question 15

What is the gold standard investigation for gout diagnosis?

Answer 15

Joint aspiration showing needle-shaped crystals under negative birfringence

Question 16

Describe the pharmacological management of acute gout attack (4)

Answer 16

1) NSAIDs
2) Colchinine (careful not to overdose - severe diarrhoea)
3) Corticosteroids
4) Other analgesia e.g. paracetamol

Question 17

Dehydration is a trigger for gout. True/false?

Answer 17

True

Question 18

Prophylaxis of gout attack is indicated if how many attacks in 6 months?

Answer 18

> 2, or tophi/radiographic signs/ renal stones present

Question 19

Urate-lowering drugs include

Answer 19

Allopurinol & febuxstat

Question 20

Urate-lowering therapy is commenced at a high dosage. True/false?

Answer 20

False - start low, go slow

Question 21

Psuedogout affects which type of cartilage?

Answer 21

Fibrocartillage (e.g. knees, wrists, ankles)

Question 22

Psuedogout is associated with diet or alcohol intake. True/false?

Answer 22

False - no association

Question 23

Psuedogout is caused by which chemical?

Answer 23

Calcium pyrophosphate dihydrate

Question 24

Psuedogout gives which shape of crystals?

Answer 24

Rhomboid

Question 25

Gout is a risk factor for development of psuedogout. True/false?

Answer 25

True

Question 26

What's the important treatment difference between psuedogout and gout?

Answer 26

Psuedogout does NOT respond to allopurinol/febuxostat

Question 27

Milwaukee shoulder is caused by deposition of which chemical?

Answer 27

Hydroapatite

Question 28

What's the common side effect of colchicine?

Answer 28

Diarrhoea

Question 29

Acute gout treatment options (3)

Answer 29

1) Analgesia (paracetamol PO and topical; NSAIDs if not contraindicated) 2) Colchicine (side effect; diarrhoea) 3) Steroids (IA)

Question 30

Gout prophylaxis treatment options (3)

Answer 30

1) Allopurinol 2) Febuxostat 3) Uricosurics

Question 31

Allopurinol and febuxstat work how?

Answer 31

Inhibit xanthine oxidase (blocking conversion of purines into uric acid)

Question 32

Why are allopurinol / febuxostat NOT used in acute gout attack?

Answer 32

A rapid change in uric acid level can precipitate further gouty attacks

Question 33

When is febuxostat preferred over allopurinol?

Answer 33

In those with RENAL impairment (allopurinol is renally cleared)

Question 34

``` Which general class of condtion contraindicates febuxostat? ```

Answer 34

Ischaemic heart disease

Question 35

Probenecid and sulphinpyrazone are examples of what type of drug?

Answer 35

Uricosurics

Question 36

Side effects of allopurinol (2)

Answer 36

1) Rash | 2) Vasculitis

Question 37

Allopurinol should NEVER be co-prescribed with what drug?

Answer 37

-Azathioprine (due to bone marrow suppression)

Question 38

Adverse effects of steroids include (5)

Answer 38

1) Central weight gain 2) Muscle wastage 3) Skin atroph 4) DM & Hypertension 5) AVN of femoral head

Question 39

Serum urate is a useful diagnostic marker for gout attacks, T/F?

Answer 39

False - is normal in 25% of acute attacks

Question 40

When is the best time to measure serum urate for gout diagnosis?

Answer 40

2 weeks after an attack

Question 41

What non-foot areas can gout affect?

Answer 41

ankle, knee, upper limb joints, spine

Question 42

What are the CRP/PV values in gout?

Answer 42

Raised.

Question 43

X-ray is a useful tool for diagnosis of acute gout attack, T/F?

Answer 43

False - usually positive in acute attacks, will show erosive changes if gout has been present for years

Question 44

When should gout prophylaxis therapy be commenced following gout?

Answer 44

2-4 weeks post-attack

Question 45

How is Milwaukee shoulder diagnosed?

Answer 45

Alizarin stain & under aspirate no crystals are seen on polarised light

Question 46

When is febuxostat contraindicated?

Answer 46

In those with IHD (safe in renal impairment)