Crystal Arthropathies

Question 1

what is gout

Answer 1

A clinical syndrome resulting from the deposition of monosodium urate crystals

Question 2

typical population with gout

Answer 2

men 30-50

postmenopausal women

Question 3

4 stages of gout

Answer 3

Asymptomatic Hyperuricemia
Acute Gouty arthritis
Intercritical Gout- time between attacks when certain
things should be considered
Chronic tophaceous Gout- huge deposits of uric acid

Question 4

MC place to have a gout attack

Answer 4

1st MTP

Question 5

how long does a pt have to have hyperurecemia to have a inceased change of getting a gout attack

Answer 5

15-20 yrs- thats why the therapy also take so long to decrease the amt in body

Question 6

yellow subcutaneous nodules are very indicative of…

Answer 6

gout

Question 7

how do you definitively dx gout

Answer 7

needle aspiration of joint!

Question 8

how do you describe the needle aspiration of gout

Answer 8

CRYSTALS-NEEDLE SHAPED, STRONGLY NEGATIVE BIREFRINGENT

Question 9

tx for acute gout attack

Answer 9

NSAIDs
steroids
colchicine

Question 10

how do you treat a second gout attack

Answer 10

-Never start during an acute attack (but can continue it)
-After the acute attack is resolved, begin prophylactic treatment with either a NSAID or low dose prednisone or colchicine 0.6 mg BID
-One week later, gradually begin allopurinol starting at 100 mg daily. May repeat uric acid level and titrate upwards every 2-5 weeks.
-Titrate allopurinol up: Average allopurinol dose is 300 mg daily, but some require higher dose (up to 800 mg daily)
GOAL is to reach a serum uric acid ≤ 6.0 mg/dl (even below 5.0 mg/dl in patients with tophi)
-Prophylaxis may be stopped after reaching the goal. But the allopurinol should stay forever

Question 11

what is the goal for serum uric acid in gout

Answer 11

serum uric acid ≤ 6.0 mg/dl (even below 5.0 mg/dl in patients with tophi)

Question 12

allopurinol most IMP SA

Answer 12

rash:
Allopurinol Hypersensitivity Syndrome: Severe cutaneous reaction (Toxic epidermal necrolysis and Stevens-Johnson Syndrome with fever, hepatitis, eosinophilia, acute renal failure

Question 13

do you start low or high dose allopurinol for long term gout tx

Answer 13

low- look for rash first

Question 14

if you have a rash with allopurinol what can you use instead

Answer 14

Febuxostat (Uloric®)

Question 15

problem with Pegloticase (Krystexxa®) in LT gout tx

Answer 15

body can creat antibodies to it and stop responding to it

Question 16

radiographic evidence of gouty arthritis

Answer 16

Large, punched out erosions with overhanging edges

Question 17

what does CPPD stand for and what is it

Answer 17

Calcium Pyrophosphate Deposition Disease (CPPD)

• Deposits occur producing calcification of articular cartilage, synovium menisci, and periarticular tissues
• Can be asymptomatic or presents with a variety of clinical syndromes (only one of which is “pseudogout”)

Question 18

clue for pseudogout on radiograph

Answer 18

• Calcification in the triangular ligament* around the wrist

- can see meniscal calcification on knee

Question 19

CPPD dx

Answer 19

Aspiration of a joint demonstrating a rod shaped, weakly positive birefringence crystal

Characteristic intra-articular calcified deposits in synovium, articular cartilage, or menisci