Crystal Arthropathies Flashcards
which two conditions make up the crystal arthropathies
gout and pseudogout
what is the pathogenesis of gout
high uric acid levels in blood causes urate to no longer be soluble, causes formation of urate crystals which build up in joints causing pain and swelling
uric acid is the final product in the breakdown of what substance
purines - found in beer and red meat
list causes that increase urate production
high content purine foods
enzyme defects
psoriasis
list causes that reduce excretion of urate from the kidneys
diuretics
chronic renal impairment
hypothyroidism
volume depletion eg heart failure
how does gout present
acute monoarthropathy with severe inflammation
hot swollen painful joint
possible gouty tophi
usually lasts 7-10 days and may resolve on its own
which joints does gout typically affect
usually first MTP but also ankle, foot and small joints of the hand
what is the acute and chronic treatment for gout
acute - NSAIDs, corticosteroids or colchicine if cannot tolerate NSAIDs
chronic - allopurinol or febustat to prophylactically reduce urate levels
what are the investigations and findings seen with gout
serum urate levels raised
polarised light microscopy showing negatively bifringent needle shaped crystals
late disease shows punched out lesions on x-ray
pseudogout is the deposition of what type of crystals
calcium pyrophosphate
who does pseudogout typically affect
the elderly and people with hyperparathyroidism, hypothyroidism and haemochromatosis
what are the findings on x-ray and polarised light microscopy for pseudogout
x-ray - chondro calcification
light microscopy - weakly positive bifringent rhomboid shaped crystals
what is the treatment for pseudogout
acute attacks NSAIDs, steroids and ocassionally colchicine
no prophylactic treatment
