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Year 3: Block 1: MSK system > Crystal arthropathies > Flashcards

Crystal arthropathies Flashcards

1
Q

Characterised by ?

A

deposition of mineralised material within joints and peri-articular tissue
COMMON

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2
Q

Common crystal deposition diseases (3)

A

Monosodium urate - gout

Calcium pyrophosphate dihydrate (CPPD) - Pseudogout

Basic calcium phosphate hydroxy-apatite (BCP) – calcific periarthritis/tendonitis

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3
Q

2/3 of urate in body comes from

A

purine metabolism

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4
Q

urate excreted in ?

A

70% kidney

30% biliary tract

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5
Q

reduced renal clearance of urine is most common cause of?

A

hyperuricaemia

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6
Q

hyperuricaemia - overproduction

A

malignancies, tumour lysis, chemo patients (high cell turnover and break down)

  • psoriasis and gout
  • alcohol
  • inborn erros or metabolism
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7
Q

hyperuricaemia - overproduction deficiency ?

A

HGPRT

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8
Q

hyperuricaemia - UNDEREXCTRETION (6)

A
  • renal impairment
  • hypetension
  • hypothyroidism
  • drugs - alcohol, aspirin
  • exercise, starvation, dehydration
  • lead poisoning

over indulgence in alcohol

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9
Q

Genetic problems? Lesch nyan syndrome deficiency?

  • features of this syndrome
A

HGPRT
- X linked recessive

  • self mutation
  • gout
  • renal disease
  • aggressive and impulse behaviour
  • intellectual disability
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10
Q

Gout is more common in?

A

men

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11
Q

Hypoxanthine-guanine phosphoribosyl transferase (HPRT) normally plays a key role in the ?

A

recycling of the purine bases, hypoxanthine and guanine, into the purine nucleotide pools.

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12
Q

Absence of HPRT

A

purine bases cannot be salvaged; instead, they are degraded and excreted as uric acid

  • synthetic rates for purines is accelerated - compensates for loss - overproduction of uric acid
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13
Q

Classic history of gout?

A

more sun exposure, alcohol, dehydrated

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14
Q

Episodes often occur in what joint?

Often starts?

A

MTP

OVERNIGHT

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15
Q

Episodes often occur in what joint?
Often starts?

episodes last how long?

A

MTP

OVERNIGHT

5-7 days - erythema of skin, hot and shiny

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16
Q

Tophi are see over - what causes this?

A

bony surfaces

  • white appearance during skin
  • massive accumulation of uric acid
17
Q

Investigation of gout

A

aspirate the joint

18
Q

What would yo used under microscope for gout?

A

crystals

19
Q

Management of Gout - acute flare

A

NSAIDs
Colchicine - diarrhoea
Steroids - I/A, I/M, oral

20
Q

Management of Gout - HYPERURICAEMIA??

a 1st attack is not treated unless? (3)

A

Single attack of polyarticular gout
Tophaceous gout
Urate calculi
Renal insufficiency

-Prophylactically prior to treating certain

21
Q

What do we not treat?

A

asymptomatic hyperuricaemia

22
Q

Lowering uric acid - commonly used drugs? (4)

A

Allopurinol

Febuxostat - avoid in patients with cardiac history

Uricosuric agents e.g. sulphinpyrazone, probenecid, benzbromarone

Canakinumab

23
Q

Rules for lowering uric acid levels? (3)

A
  • Wait until the acute attack has settled before attempting to reduce the urate level
  • Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
  • Adjust allopurinol dose according to renal function - (increase it up monthly)
24
Q

really important in patients with gout to assess?

A

cardiovascular and lifestyle factors

25
Q

Pseudogout - joint?

who does it typically effect?
flares are often?

A

knee

older women
erratic

26
Q

triggers of Pseudogout

A

Trauma, Intercurrent illness

27
Q

In pseudogout you see?

A

Chondrocalcinosis on an XRAY

28
Q

Aspirating joint in Pseudogout - what will you see?

A

rhomboid crystals

hard to find

29
Q

Management of Pseudogout? (3)

A

NSAIDs
I/A steroids (inter articular)

There are no prophylactic therapies

30
Q

Polymyalgia Rheumatica is a?

close relationship with?

A

inflammatory condition of the elderly

  • giant cell arteritis (high serum anaemia)
31
Q

Polymyalgia Rheumatica - how many patients may have evidence of GCA

A

20%

32
Q

Polymyalgia Rheumatica - symptoms (5)

female to male ratio?

A

sudden onset - shoulder +/- pelvic girdle STIFFNESS

  • anaemia
  • malaise, WL, fever, depression
  • Arthralgia / synovitis occasionally
  • usually in over 70’s

2:1

33
Q

Polymyalgia Rheumatica - diagnosis

ESR greater than?

A 
Compatible history
Age > 50
ESR > 50
Dramatic steroid response 9n 48 hours
No specific diagnostic test
34
Q

Differential diagnosis of Polymyalgia Rheumatica? give examples of what it could be? (6)

A
  • Myalgic onset Inflammatory joint disease
  • Underlying malignancy
    e. g Multiple myeloma, lung cancer
  • Inflammatory muscle disease (mysitis)
  • Hypo/ hyperthyroidism
  • Bilateral shoulder capsulitis (can present with stiff shoulders)
  • Fibromyalgia
  • look for temporal artery tenderness
35
Q

Polymyalgia Rheumatica? - treatment (3)

under 65’s and over 65’s?

A
  • Prednisolone 15mg per day initially - often start on that for 4 weeks
  • 18-24 mth course
  • Bone prophylaxis

in under 65’s - DXA scan
over 65’s - fractures - bone protection along with the steroids

36
Q

. In the vast majority of people with gout, hyperuricaemia results from ?

A

reduced efficiency of renal urate clearance

Year 3: Block 1: MSK system (22 decks)

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