crystal arthropathies

Question 1

what is the overall cause of gout

Answer 1

hyperuricaemia

Question 2

what are the two causes of hyperuricaemia

Answer 2

increased production of uric acid

reduced excretion of uric acid

Question 3

give examples of conditions which would cause increased production uric acid

Answer 3

idiopathic
HGPRT deficiency 
increased cell turnover (psoriasis, cancer after chemo)
alcohol
high dietary intake of purine

Question 4

in which products is purine found

Answer 4

red meat
seafood
beer

Question 5

what condition involves a HGRPT deficiency

Answer 5

Lysch Nyhan syndrome

Question 6

give examples of conditions which would cause reduced excretion of uric acid

Answer 6

CKD
volume depletion e.g. HF
hypothyroidism
drug side effect e.g. thiazide diuretic

Question 7

what counts as a reduced excretion of uric acid

Answer 7

> 0.42 mmol/L

Question 8

how is uric acid produced

Answer 8

end product of purine synthesis

Question 9

what are the purine bases

Answer 9

adenine

guanine

Question 10

describe the symptoms of acute gout

Answer 10

monoarthropathic
abrupt onset, usually overnight
may have normal uric acid levels during this attack

Question 11

what is the treatment of acute gout

Answer 11

NSAIDs
colchicine
steroids (oral or IM)

Question 12

describe the symptoms of chronic gout

Answer 12

chronic joint inflammation
tophi is present
high serum uric acid
may get acute attacks

Question 13

what is the prophylaxis for gout, when should it be started

Answer 13

2-4 weeks after an acute attack

allopurinol + steroid
febuxostat
NSAIDs

Question 14

when should life-long prophylaxis be given

Answer 14

> 1 attack per year
renal failure is present
on a diuretic that can’t be stopped e.g. Hf
if undergoing chemo

Question 15

what are the clinical findings of gout

Answer 15

precipitation of crystal in joints or soft tissues (tophi)
secondary degenerative changes in the joint
renal disease

Question 16

what are the pathological findings of gout

Answer 16

joint fluid will have needle shaped crystals under cross-polarised light
amorphous eosinophilic debris and inflammation with giant cells

Question 17

what investigations are done for gout, what would you expect to find

Answer 17

raised inflammatory markers
raised serum uric acid
polarising microscopy of synovial fluid = needle-shaped negatively birefringent crystals
x-rays

Question 18

what is pseudo-gout also known as

Answer 18

chondrocalcinosis

CPPD

Question 19

what is the cause of pseudo-gout

Answer 19

calcium pyrophosphate = acute attacks

calcium hydroxylappatite Crystal deposits

Question 20

what conditions may lead to pseudo-gout

Answer 20

idiopathic 
hypercalcaemia
haemachromatosis
ochronsis
hypohyroidism

Question 21

where is hydroxyapatite found, what is it’s role

Answer 21

normal component of bone and teeth, supplies them with their rigidity

Question 22

what does groups of hydroxyapatite cause

Answer 22

release of collagenases, serine proteinases and IL-1

Question 23

what are the symptoms of pseudo-gout

Answer 23

asymptomatic
acute or chronic joint pain
milwaukee shoulder
acute and rapid deterioration

Question 24

what investigations are done for pseudo-gout, what would you expect to find

Answer 24

microscopy = rhomoid shaped crystal, thicker and bigger than needle-shaped rate crystals

x-rays - dense deposits can be seen

Question 25

what is the treatment of pseudo-gout

Answer 25

NSAIDs
colchicine
steroids
rehydration
intra-articular steroid injection
physio
partial or total arthroplasty

Question 26

what is the Buzzword for pseudo-gout

Answer 26

milwaukee shoulder