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Y4: Rheumatology > Crystal arthropathies > Flashcards

Crystal arthropathies Flashcards

1
Q

What are the crystal arthropathies?

A
  • Gout
  • Psuedogout (Calcium pyrophosphate deposition (CPPD))
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2
Q

Describe gout?

A
  • Acute monoarthropathy with severe joint inflammation (MTP of big toe)
  • Monosodium urate crystals in synovial joints
    • Raised plasma urate
  • Can be precipitated by surgery, starvation, infection, diuretics
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3
Q

What are the differentials for gout?

A
  • Exclude septic arthritis (acute monoarthropathy)
  • Reactive arthritis, haemarthrosis, CPPD
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4
Q

Describe the risk factors for gout?

A
  • Increasing age
  • Reduced urate excretion
    • Elderly, men, post-menopausal females, hypertension
    • Diuretics, anti-HTN, aspirin
  • Excess urate production
    • Alcohol, red meat, seafood, sweeteners
    • Alcohol, warfarin, cytotoxics
    • Myelo- and lymphoproliferate, psoriasis
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5
Q

Describe the pathophysiology of gout?

A
  • Imbalance of uric acid synthesis and elimination
  • Removed via kidneys (2/3) and gut (1/3)
  • Xanthine oxidase plays important role in producing uric acid
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6
Q

Clinical features of gout?

A
  • Rapid-onset, acute monoarthritis
    • 1st MTP joint in 50% of cases
  • Also ankle, midfoot, knee, small hand joints, wrist and elbow
  • Severe pain and tenderness
  • Swelling with overlying red, shiny skin
  • Tophi form from cystal deposits
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7
Q

Screening in gout?

A
  • Gout is a risk factor for CV and renal disease mortality
  • Screen for CKD, hypertension, dyslipidaemia and diabetes
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8
Q

Describe the investigations into gout?

A
  • Polarized light microscopy of synovial fluid
    • Negatively birefringent urate cystals
  • Serum urate (raised)
  • X-rays
    • Soft tissue swelling
    • Punched out erosions in bone
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9
Q

What are the different causes of hyperuricaemia and gout?

A
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10
Q

What drugs can cause hyperuricaemia and gout?

A
  • Diuretics
  • Aspirin
  • Ciclosporin
  • Pyrazinamide
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11
Q

Describe the treatment of acute gout?

A
  • NSAIDs + PPI
  • Colchicine (effective but slower to work)
  • Corticosteroids
  • Rest + elevate joint + ice packs
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12
Q

What is problematic in the treatment of acute gout?

A

NSAIDs + colchicine are problematic in renal impairment

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13
Q

Describe some prevention measures for acute gout?

A
  • Lose weight
  • Avoid fasts, alcohol excess and purine-rich meats
  • If symptomatic or >1 attack in 12 months
    • Allopurinol
  • If allopurinol is CI:
    • Febuxostat
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14
Q

Indications for the use of urate-lowering drugs?

A
  • Tophi
  • Recurrent attacks
  • Evidence of bone/joint damage
  • Renal impairment/calculi
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15
Q

What is the first line urate lowering therapy?

A

Allopurinol

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16
Q

Describe Allopurinol?

A
  • Xanthine oxidase inhibitor
    • Reduced conversion of hypoxanthine/xanthine to uric acid
  • Acute flares normally occur on intiation of Allopurinol
  • SEs: Rash, fever, reduced WCC
17
Q

Describe Febuxostat?

A
  • Xanthine oxidase inhibitor
  • 2nd line for urate-lowering therapy
  • SE: increased LFTs
    • Hepatic metabolism
  • More effective than Allopurinol
18
Q

What is pictured here?

A

Acute monoarthritis in gout

19
Q

What is pictured here?

A

Ulcerated tophi in gout

20
Q

What is pictured here?

A
  • Gout
  • Needle-shaped monosodium urate crystals
  • Negative birefringence under polarized light
21
Q

What is pictured here?

A
  • Psuedogout
  • Rhomboid-shapred CPPD crystals
  • Positive birefringence in polarized light
22
Q

Describe Acute CPPD crystal arthritis?

A
  • Acute monoarthropathy
  • Deposition of calcium pyrophosphate dihydrate cystals
  • Usually of larger joints in the elderly
  • Can be provoked by illness, surgery or trauma
23
Q

Describe Chronic CPPD?

A
  • Inflammatory symmetrical polyarteritis and synovitis
  • Can be mistaken for RA
24
Q

What are the risk factors for CPPD?

A
  • Age
  • Osteoarthritis
  • Hyperparathyroidism
  • Haemachromatosis, wilson’s
  • Hypophosphataemia/hypomagnesaemia
25
Q

Clinical features of pseudogout?

A
  • Swollen tender joint with a large effusion
    • Majority are of the knee
  • Fever
  • Confusion may be present
26
Q

Describe the investigations for CPPD?

A
  • Polarized light microscopy of synovial fluid
    • Weakly positive birefringent crystals
  • X-rays
    • Soft tissue calcification
27
Q

Describe the mangement of CPPD?

A
  • Aspiration often provides symptomatic relief
  • Acute attacks:
    • Intra-articular steroids
  • Prevention of acute attacks:
    • NSAIDs (+PPI) +/- colchicine
  • Early active mobilisation is important
28
Q
A

Y4: Rheumatology (19 decks)

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