Crystal Arthropathies

Question 1

state the most common crystal arthropathy

Answer 1

gout

Question 2

what crystals are deposited in the joint in those with gout?

Answer 2

urate

Question 3

urate crystals are due to high levels of what?

Answer 3

serum uric acid levels (hyperuricaemia)

Question 4

uric acid is the final compound in the breakdown of purines in DNA metabolism - name the 2 purines

Answer 4

adenine and guanine

Question 5

name the 2 causes of hyperuricaemia

Answer 5

underexretion or excessive intake:

renal failure or diuretics or due to excessive alcohol, red meat and sea food intake

Question 6

what can uric acid be triggered by?

Answer 6

dehydration
trauma
surgery

Question 7

name the most common joint affected by gout

Answer 7

first metatarsalphalangeal (MTP) joint - podagra

ankle and knee also

Question 8

clinical signs and symptoms of gout?

Answer 8

intensely painful red, hot swollen joint which may mimic a septic arthritis

Question 9

how long do symptoms last in gout?

Answer 9

7-10 days if untreated then resolve

Question 10

name the painless white accumulations of uric acid which can occur in the soft tissues and occasionally erupt through the skin

Answer 10

gouty tophi

Question 11

what can chronic gout result in?

Answer 11

destructive erosive arthritis

Question 12

name the test performed to make a definitive diagnosis of gout

Answer 12

polarised microscopy

Question 13

what do uric acid crystals look like under polarised microscopy?

Answer 13

needle shaped

strong (negative) birefringence - yellow to blue

Question 14

acute gout treatment?

Answer 14

NSAIDs
corticosteroids
opioid analgesics

Question 15

recurrent attack gout treatment?

Answer 15

rate lowering therapy - allopurinol

only start after the acute phase has died or eye it exacerbates it

Question 16

name the other common crystal arthropathy

Answer 16

pseudogout

Question 17

name the crystals that cause pseudogout

Answer 17

calcium pyrophosphate crystals

Question 18

what is the term used when calcium pyrophosphate deposition occurs in cartilage and other soft tissues in the absence of acute inflammation

Answer 18

chondrocalcinosis

Question 19

name the umbrella that pseudogout and chondrocalcinosis come under

Answer 19

Calcium Pyrophosphate Deposition Disease (CPPD)

Question 20

name the joints that CPPD affects

Answer 20

knee
wrist
ankle

Question 21

what does CPPD coexist with?

Answer 21

hyperparathyroidism
hypothyroidism
renal osteodystrophy
haemochromatosis
Wilson’s disease

Question 22

treatment of acute attacks of pseudogout?

Answer 22

NSAIDs

corticosteroids

Question 23

are there any medications used in the prophylaxis of gout?

Answer 23

no

Question 24

what type of arthritis can pseudogout cause?

Answer 24

OA

Question 25

what shape are pseudogout crystals

Answer 25

rhomboid-rod like weak birefringence - blue to yellow