Crystal Arthropathies Flashcards
Chronic tophaceous gout can develop in one to two years in patients taking, which medication?
Cyclosporine
What x-ray changes do you see with gout?
Punched out lytic lesion with overhanging bony edges
What is the treatment of acute gout if there is no response to first line agent?
IL-1 inhibitor
What are the recommendation for starting hypouricemic therapy indications?
- More than 2 attacks of gout/year
- More than 1 tophi
- X-ray damage
- CKD stage 3
- -Uric Acid concentration >9
When starting hypouricemic therapy what should also be started?
Low dose colchicine or NSAID or Steroid and this should be continued for 3-6 months
Whats the uric acid goal for gout patients?
Uric acid level <6
What medication dose should be reduced when prescribing Allopurinol?
Azathioprine and 6 MP
Before starting Allopurinol what should be checked and on what patient population?
HLA B5801 in Korena, Han chinese, Thai, African american
Febuxostat has been found to increase what type of mortality?
Cardiovascular
What is the indication for using Pegloticase?
What should be ruled out before starting it?
When all intervention fails in treating gout and patient
Uric acid is not at target+ >2 acute attacks per year or nonresolving tophi
G6PD deficiency
What medication when combined with allopurinol has been found to achieve uric acid levels?
Lesinurad
USe only in combination with allopurinol when GFR is >40
What is the ray finding in pseudogout (Calcium pyrophosphate deposition Disease)?
Chondrocalcinosis
What diseases are associated with Calcium pyrophosphate deposition Disease?
Primary hyperparathyroidim Hemochromatosis Hypophosphatemia Hypomagesemia Hypothyroidism Familial Hypocaciuric hypercalcemia
How does Calcium hydroxyapatite crystals deposition disease (Basic calcium phosphate disease) appear?
Snowball-like aggregate because invidual crytals are too small.
Can cause Milwaukee shoulder syndrome in large joints causing a destructive arthropathy and rotator cuff tear due to hydroxyappetite crystal.
What are the 3 inflammatory myopathies?
- Polymyositis-Proximal muscle weakness and elevated CPK
- Dermatomyositis- Proximal+Skin, increase CPK
- Inclusion Body Myositis-NL CPK
What are the clinical signs of inflammatory myopathie?
- Proximal muscle involvement causing inability to get up from chair, climb stairs, or comb hair
- Dermatomyositis and Polymyositis have no Facial involvement
- Incluion body myositis= Face may be involved; Dysphagia may occur
What are the characteristic rash seen in Dermatomyositis?
Heliotrope Rash-Bluish purple discoloration of the upper eyelid
Gottron’s Rash
V-sign=rash of upper chest, upper back rash (shawl sign)
What cancer can we see with Dermatomyositis and late onset polymyositis?
Lung Ovarian Breast Melanoma Colon cancer
What does Biopsy show in the inflammatory myopthies?
Polymyositis: CD8 T-cell infiltrates within the muscle fascicles
Dermatomyositis: Inflammatory (B cells and CD4 T cells outside the muscle fascicle in the interfascicular septae
Inclusion Body Myositis: Rimmed vacuoles with inclusions. CD8 T-cell infiltrates within the muscle fascicles
What are the autoantibodies seen in the inflammatory myopthies?
- Anti-Jo1=Associated with ILD in patients with polymyositis
- Anti-SRP=seen mostly in black woman, present wtih severe weakness, cardiac involvement, and onset during fall. NO rash seen
- Anti Mi2: Dermatomyositis with V and Shawl signs.
What are the IgG4 related disease?
These disorders are fibroinflmammatory conditions with subacute onset with tumor like lesions of the involved organ, assoicated fibrosis, lymphoplasmacytic infiltrate rich in IgG4 positive plasma cells.
- Autoimmune pancreatitis
- Retroperitoneal fibrosis
- Riedel’s thyroiditis
- Orbital pseudotumor
- Sclerosing mesenteritis
- Miculicz’s syndrome
How does Meniscal injury present and what test is used to diagnose it?
Present secondary to trauma with knee joint swelling, locking and clicking, or giving away
McMurray test:
- Painful click with inward motion=Lateral meniscal tear
- Painful click with outward motion=Medial meniscal tear
How does Knee ligament injuries present?
Injury after high-energy trauma
Popping sensation
Swelling and pain within 1-2 hrs
-Knee INSTABILITY of the joint is the key feature
What test do we use for
MCL
LCL
ACL?
How do we treat Collateral ligament tears vs Cruciate?
MCL=Valgus
LCL=Varus
Anterior Cruciate and Posterior Cruciate= Drawer sign
Torn Collateral ligaments usually heal without surgery. Torn cruciate ligaments need surgery