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MSK > Crystal Arthropathies > Flashcards

Crystal Arthropathies Flashcards

1
Q

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

A

Inflammatory. Urate crystals

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2
Q

Gout is more common in which sex?

A

Men

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3
Q

What’s the most common inflammatory arthritis in men?

A

Gout

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4
Q

Gout is how much more common than RA?

A

10x

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5
Q

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

A

> 7mg/dL

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6
Q

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

A

True

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7
Q

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

A
  • Lesch-Nyhan Syndrome

- Von Gierke Disease

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8
Q

Psoriasis can predispose to gout. True/false?

A

True

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9
Q

Which drugs can cause gout? (4)

A

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

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10
Q

Which foods are rich in purines? (4)

A
  • Red meat
  • Offal
  • Shellfish
  • Legumes
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11
Q

Gout generally affects which joint?

A

1st MTP

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12
Q

Differential diagnoses for gout include (3)

A

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

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13
Q

Cutaneous deposition of uric acid leads to which sign?

A

Tophi

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14
Q

Inflammatory markers are raised in gout. True/false?

A

True

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15
Q

What is the gold standard investigation for gout diagnosis?

A

Joint aspiration showing needle-shaped crystals under negative birfringence

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16
Q

Describe the pharmacological management of acute gout attack (4)

A

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

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17
Q

Dehydration is a trigger for gout. True/false?

A

True

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18
Q

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

A

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

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19
Q

Urate-lowering drugs include

A

Allopurinol & febuxstat

20
Q

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

A

False - start low, go slow

21
Q

Psuedogout affects which type of cartilage?

A

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

22
Q

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

A

False - no association

23
Q

Psuedogout is caused by which chemical?

A

Calcium pyrophosphate dihydrate

24
Q

Psuedogout gives which shape of crystals?

A

Rhomboid

25
Q

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

A

True

26
Q

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

A

Psuedogout does NOT respond to allopurinol/febuxostat

27
Q

Milwaukee shoulder is caused by deposition of which chemical?

A

Hydroapatite

28
Q

What’s the common side effect of colchicine?

A

Diarrhoea

29
Q

Acute gout treatment options (3)

A

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

30
Q

Gout prophylaxis treatment options (3)

A

1) Allopurinol
2) Febuxostat
3) Uricosurics

31
Q

Allopurinol and febuxstat work how?

A

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

32
Q

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

A

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

33
Q

When is febuxostat preferred over allopurinol?

A

In those with RENAL impairment (allopurinol is renally cleared)

34
Q 
Which 
general class of condtion contraindicates febuxostat?
A

Ischaemic heart disease

35
Q

Probenecid and sulphinpyrazone are examples of what type of drug?

A

Uricosurics

36
Q

Side effects of allopurinol (2)

A

1) Rash

2) Vasculitis

37
Q

Allopurinol should NEVER be co-prescribed with what drug?

A

-Azathioprine (due to bone marrow suppression)

38
Q

Adverse effects of steroids include (5)

A

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

39
Q

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

A

False - is normal in 25% of acute attacks

40
Q

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

A

2 weeks after an attack

41
Q

What non-foot areas can gout affect?

A

ankle, knee, upper limb joints, spine

42
Q

What are the CRP/PV values in gout?

A

Raised.

43
Q

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

A

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

44
Q

When should gout prophylaxis therapy be commenced following gout?

A

2-4 weeks post-attack

45
Q

How is Milwaukee shoulder diagnosed?

A

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

46
Q

When is febuxostat contraindicated?

A

In those with IHD (safe in renal impairment)

MSK (21 decks)

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