Crystal Arthropathies Flashcards
What is deposited in gout
Monsodium urate
What is deposited in psuedogout
Calcium pyrophosphate dihydrate (CPPD)
What is deposited in calcific periarthritis/tendonitis
Basic calcium phosphate hydroxy-apatite (BCP)
What are tophi?
Massive accumulations of uric acid
Overproduction causes of hyperuricaemia
Malignancy Severe exfoliative psoriasis Drugs Inborn errors of metabolism HGPRT deficiency
Underexcretion causes of hyperuricaemia
Renal impairment Hypertension Hypothyroidism Drugs Exercise, starvation and dehydration Lead poisoning
What is Lesch Nyan Syndrome
HGRPT defiency X linked recessive Intellectual disability Impulsive and aggressive behaviour Self mutilation Gout Renal disease
Management of an acute flare of gout
NSAIDs
Colchicine
Steroids IA,IM, oral
Management of hyperuricaemia - when to treat?
1st attack not treated unless - single attack of polyarticular, topahceous gout, rate calculi, renal insufficiency
Treat if 2nd attack with year
Prophylactically prior to treatment of some malignancies
DO NOT treat asymptomatic
Management of hyperuricaemia - how to treat
Lower uric acid - xanthine oxidase inhibitor (allopurinol), Febuxostat, uricosuric agents, canakinumab
Address cardiovascular and lifestyle factors
Psuedogout features
Elderly females
Erratic flares - most commonly knee
Aetiology - idiopathic, familial, metabolic
Triggers -trauma, intercurrent illness
Management of psuedogout
NSAIDs
I/A steroids
Polymyalgia Rheumatica features
Inflammatory condition of elderly - usually over 70
Close relationship with GCA
Sudden onset of shoulder +/-pelvic girdle stiffness
ESR > 45 often 100
Anaemia, malaise, weigh loss, fever, depression
Polymyalgia rheumatica treatment
Prednisolone 15mg per day
18-24 month course
Bone prophylaxis
