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Y2 Rheumatology > Crystal Arthropathies > Flashcards

Crystal Arthropathies Flashcards

1
Q

Pathology of Gout

A

Deposition of urate crystals within a joint
usually due to hyperuricaemia
Uric acid is the final compound in breakdown of purines in DNA metabolism
Uric crystals precipitate in joints - triggered by dehydration, trauma, surgery

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2
Q

Hyperuricaemia can be due to

A

renal excretion - exacerbated by diuretics/ renal failure
excessive alcohol intake
excessive red meat
excessive seafood

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3
Q

Which joint is classically involved in gout and what is it called if it’s affected?

A

1st MTP joint - Podagra

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4
Q

Joints affected by Gout

A

1st MTP joint, ankle, knee

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5
Q

Symptoms of Gout

A

Intensely painful, red, hot, swollen joint (mimic septic arthritis)
lasting for 7-10 days if untreated
then resolve

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6
Q

What is gouty tophy

A

painless white accumulations of uric acid in soft tissues

occasionally erupt through the skin

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7
Q

What may chronic gout lead to?

A

Destructive erosive arthritis

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8
Q

Investigations of Gout

A

Synovial fluid

  • gram stain & culture to exclude infection
  • polarised microscopy: needle shaped uric acid crystals with negative birefringence
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9
Q

birefringence of gout

A

negative = change from yellow to blue when lined across the direction of polarization

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10
Q

Treatment of acute gout

A

NSAIDs - colchicine if can’t tolerate NSAID
corticosteroid
opioid

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11
Q

Treatment of recurrent attacks/joint destruction/ tophi (gout)

A

allopurinol
other urate lowering therapies
only once the acute attack has settled (can potentiate further flare)

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12
Q

What crystal is involved in the pathogenesis of gout?

A

Urate Crystal

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13
Q

What crystal is involved in the pathogenesis of pseudogout?

A

Calcium pyrophosphate

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14
Q

Pathology of Pseudogout

A

Acute arthritis caused by calcium pyrophosphate crystals

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15
Q

What is chondrocalcinosis

A

calcium pyrophosphate deposition occurs in cartilage/soft tissues in the absence of acute inflammation

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16
Q

CPDD

A

Calcium Pyrophosphate Deposition Disease: Pseudogout & Chondrocalcinosis

17
Q

Which joints does CPDD affect?

A

knee, wrist ankle

18
Q

What can CPDD coexist with?

A 
Hyperparathyroidism
Hypothyroidism
Renal osteodystrophy
Haemochromatosis
Wilson's disease
OA (however chronic CPDD can cause OA)
19
Q

Investigation of Pseudogout

A

Synocial fluid

  • gram stain & culture to exclude infection
  • polarised microscopy: needle shaped uric acid crystals, positive birefringence
20
Q

Birefringence of pseudogout

A

Positive

21
Q

Treatment of acute attacks of Pseudogout

A

NSAIDs
corticosteroid (systemic & intra-articular)
occasional colchicine

22
Q

Prophylaxis of Pseudogout

A

no medication used

Y2 Rheumatology (7 decks)

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