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
What is Ilitobial Band Syndrome?
Usually affects runners, cyclists, and hikers
Pain is on the outside of the knee (Vs Palaterfemoral in which pain is on the front of the knee)
What 4 muscles constitute the rotator cuff?
What test do we use to assess them?
Supraspinatus=Abduction and lifting of the arm; Drop arm test, Empty can test done
Infraspinatus- External rotation; external rotation test
Subscapularis= Internal rotation, Belly press, Lift off test
Teres Minor=External rotation; Hitchiking/Hornblower test
How does subacromial impengement present?
Pain with overhead activities; Hawkin’s test, Neer’s test-pain on forward elevation of the arm is a positive test.
How are the rotator cuff disorders managed?
If Age >65 with chronic full thickness tear=conservative management. Acute full thickness=surgery
<65=Acute ad chronic full thickness tear get surgery
What are the signs of adhesive capsulitis?
Active and Passive ROM is limted in >2 planes
PAin at the end of ROM
What are the 3 common entrapment syndrome?
Carpal Tunnel
Meralgia Paraethetica: Involves the lateral cutaneous nerve. Seen in pregnant woman and people who wear tool belts
Tarsal tunnel syndrome: involves posterior tibial nerve
How is Plantar fasciitis treated?
Conservative management: local steroid injections may be associated with increase risk of plantar fascia rupture.
resolution of symptoms occur within 12 months if not Plantar fasciotomy can be done after 12 months
How does Morton’s Neuroma present?
Thickening of the tissues surrounding the digital nerves of the toe. Mos commonly between 3rd and 4th metatarsals
Burning pain in the fore foot that radiate to the toes and may be associated with numbness of toes. Crushing toes together replicates the pain
How does metatarsal stress fracture present?
Due to repeated stress to forefoot (Dancing, running, jumping). the Secondmetatarsal is the mc site.
PAtients has pan in the forefoot. Early xray may be negative and doesnt become positive until 2-6 weeks.
Dx Clinically with pain over metatarsal shaft
What are the types of Systemic amyloidosis?
- Primary (AL or Light chain)
- Lambda or Kappa light chains hat deposit as amyloid fibrils in tissues
- Can occur in multiple myeloma, lymphoma, Waldenstroms - Secondary (AA)
- Cause by inflammatory conditions that block the AA production
How does primary amyloidosis present?
Unexplaine nephrotic syndrome Organomegaly Macroglosia LVH with diatolic dysfunction but low voltage Unexplained diarrhea or constipation
What new compound have been found to inhibit AA amyloid deposits and slow the decline of renal function?
Eprosidate
