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Musculoskeletal > Crystal Arthropathies > Flashcards

Crystal Arthropathies Flashcards

1
Q

what is gout

A

inflammation in the joint triggered by uric acid crystals

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2
Q

what is the value that indicates hyperuricemia in gout

A

>0.42mmol/l

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3
Q

what is the prevalence of gout

A

1.4 in UK, 3.9 in US 7% in men over 65 and 3% in women over 85 male > female

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4
Q

what is affected during acute gout

A

monoarthropathy = 1st MTP > ankle > knee usually an abrupt onset over night

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5
Q

how long does acute gout take to settle

A

10 days without treatment 3 days with treatment

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6
Q

what is uric acid levels during attack of gout

A

it may be normal

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7
Q

what is chronic gout usually associated with

A

diuretics

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8
Q

what is uric acid levels in chronic gout

A

high it is the deposit of uric crystals in people with long standing hyperuricaemia

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9
Q

what happens during chronic gout

A

they may get acute attacks

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10
Q

what is the cause of gout

A

either increased urate production or reduced urate excretion

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11
Q

what is the more common cause of gout

A

reduced urate excretion

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12
Q

what causes increased urate production

A

inherited enzyme defects (HGPRT) myeloproliferative / lymphoproliferative disorders psoriasis haemolytic disorders alcohol (beer, spirits) high dietary purine intake (red meat, seafood, corn syrup)

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13
Q

what causes reduced urate excretion

A

chronic renal impairment volume depletion eg heart failure hypothyroidism diuretics cytotoxics eg cyclosporine

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14
Q

how is gout diagnosed

A

raised inflammatory markers serum uric acid raised synovial fluid biopsy renal impairment (may be cause or effect) Xrays

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15
Q

what is seen in synovial fluid biopsy in gout

A

polarising microscopy shows needle shaped negatively befringement crystals

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16
Q

how is acute attack of gout treated

A

NSAIDs colchicine IA steroids (often in people unable to take above)

17
Q

what is colchicine and how does it work

A

decreases swelling and lessening the build up of uric acid crystals that cause pain in the affected joint

18
Q

what is given prophylactically in gout

A

allopurinol febexostat start 2-4 weeks after acute attack require cover with NSAIDs etc

19
Q

what is allopruinol

A

purine analog; it is a structural isomer of hypoxanthine (a naturally occurring purine in the body) and is an inhibitor of the enzyme xanthine oxidase therefore, decreases uric acid formation

20
Q

what is febexostat

A

also inhibits xanthine oxidase and therefore reduces uric acid formation

21
Q

what is difference between pseudogout and gout

A

both are caused by large crystal deposits in joint but it is different crystals

22
Q

who is pseudogout common in

A

elderly

23
Q

what does pseudogout effect

A

fibrocartilage - knees, wrist, ankles

24
Q

what are the two types of crystals in pseudogout

A

calcium pyrophosphate crystals calcium hydroxyapatite crystals

25
Q

what are the associated conditions in pseudogout

A

hyperparathyroidism familial hypocalciuric hypercalcaemia haemochromatosis haemosiderosis hypophosphatasia hypomagnesia hypothyroidism gout neuropathic joints ageing amyloidosis trauma

26
Q

how is pseudogout diagnosed

A

histology of calcium pyrophosphate crystals and marked rise in inflammatory markers

27
Q

what does calcium pyrophosphate crystals in pseudogout look like histologically

A

envelope shaped mildly positive birefringent (refractive index)

28
Q

how is pseudogout treated

A

NSAIDs Colchicine Steroids Rehydration

29
Q

what is hydroxyapatite

A

hydroxyapatite crystal deposition in or around the joint

30
Q

what does this crystal deposition in hydroxyapatite lead to

A

release of collagenases, serine proteinases and IL-1 acute and rapid deterioration

31
Q

who does hydroxyapatite affect

A

females, 50-60 years

32
Q

what is symptom of hydroxyapatite

A

Milwaukee shoulder

33
Q

what does this symptom of hydroxyapatite entail

A

limited range of motion joint pain and inflammation synovial haemorrhagic effusion

34
Q

how is hydroxyapatite treated

A

NSAIDs IA steroid injection physiotherapy partial or total arthroplasty

Musculoskeletal (55 decks)

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