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MSK > Crystal Arthropathies > Flashcards

Crystal Arthropathies Flashcards

1
Q

Define gout

A

Inflammation in the joint triggered by uric acid crystals

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2
Q

How is uric acid synthesised?

A

Dietary purines are converted into hypoxanthine then xanthine then plasma urate finally it is converted into uric acid

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3
Q

What enzyme converts hypoxanthine back to purines?

A

HGPRT

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4
Q

How does hyperuricaemia arise? What is hyperuricaemia?

A

Uric Acid >7mg/dL >0.42 mmol/l

  • excess consumption
  • over production
  • under excretion
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5
Q

What causes increased production of uric acid?

A
  • enzyme defects
  • myelo/lymphoproliferative disorders
  • psoriasis
  • haemolytic disorders
  • high dietary purine
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6
Q

What causes reduced excretion of uric acid?

A
  • chronic renal impairment
  • volume depletion
  • hypothyroidism
  • diuretics
  • cytotoxins
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7
Q

Where does gout tend to occur?

A

Monoarthropathy of 1st MTP (podagra)
Ankle
Knee

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8
Q

How long does acute gout take to settle with treatment?

A

3 days

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9
Q

How does gout present?

A

Abrupt onset, pain, tenderness, swelling, redness

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10
Q

Describe chronic gout

A

Chronic inflammation often associated with CKD, heart failure or poor compliance with treatments

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11
Q

What can be seen in the joints with chronic gout?

A

Tophi - crystalline deposits of sodium bitrate

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12
Q

State the investigations used for patients with gout

A
  • serum uric acid
  • inflammatory markers
  • renal function
  • x-ray
  • polarising microscopy
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13
Q

What will be seen on polarising microscopy?

A

negative bifringence, needle shaped crystals

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14
Q

How is acute gout treated?

A

NSAIDs
Colchine
Steroids

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15
Q

How is chronic gout treated?

A

Allopurinol, Febuxostat

Started 2-4 weeks after acute attack, NSAIDs may also be required

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16
Q

What is the target serum uric acid level on chronic gout treatment?

A

<360 micromol/l

17
Q

What happens in calcium pyrophosphate deposition disease?

A

Crystals are deposited in the cartilage and articular tissues (hyaline or fibrocartilage)

18
Q

Where does calcium pyrophosphate deposition usually occur?

A

Knees, wrists, ankles

19
Q

How do the crystals in CPDD differ from gout crystals?

A

Rhomboid shaped crystal are thicker and bigger than urate - positive birefringence

20
Q

What are the risk factors for CPDD?

A
  • age
  • hyperparathyroidism (high calcium)
  • previous cartilage problems
  • low magnesium
  • hypothyroidism
21
Q

How is CPDD treated?

A

NSAIDs, colchine, steroids, rehydration

22
Q

What is another name for hydroxyapatite crystal disease?

A

Milwankee Shoulder

23
Q

Describe milwankee shoulder

A

Usually occurs in 50-60 year old females, deposition in/around the joint leads to release of collangenases serine proteinases and IL1 - rapid deterioration

24
Q

What is the treatment for milwankee shoulder?

A

NSAIDs, steroid injections, physic and arthroplasty

25
Q

Define soft tissue rheumatism

A

pain caused by inflammation to ligaments/tendons/muscles/nerves - specific pain to a specific site

26
Q

Describe soft tissue rheumatism in the neck

A

Usually muscular and self limiting

27
Q

Describe soft tissue rheumatism in the shoulder

A

Rotator cuff tear/tendonitis
Adhesive capsulitis
Calcific tendonitis
Impingement

28
Q

Describe soft tissue rheumatism in the elbow

A

Medial/lateral epicondylitis

Cubital tunnel syndrome

29
Q

Describe soft tissue rheumatism in the wrist

A

De-Qwuervains tenosynovitis

Carpal tunnel syndrome

30
Q

Describe soft tissue rheumatism in the pelvis

A

Bursitis

Stress enthesopathies

31
Q

What soft tissue rheumatism can occur in the foot?

A

Plantar fascitis

32
Q

What investigation is required for calcium tendonitis?

A

X-ray

33
Q

How are soft tissue rheumatisms treated?

A

Pain control, rest, ice, physio, steroid injections, surgery

34
Q

Which gender is affected more by hyper mobility problems?

A

Females

35
Q

Name two genetic conditions that increase the risk of hyper mobility

A

Marfans

Ehlers Danlos

36
Q

When does hyper mobility usually present?

A

Childhood or third decade

37
Q

What scoring system is used to assess hyper mobility?

A

Beighton Score
>10 degrees hyperextension of elbows & knees (R and L)
Passive extension of fingers and thumb (R and L)
Touch floor with palms
>/= 4/9 means hyper mobile

38
Q

What are the features of hyper mobility?

A

Arthralgia, premature osteoarthritis

39
Q

How is hyper mobility managed?

A

Physio and education

MSK (22 decks)

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