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MSK > Crystal arthropathies and polymyalgia rheumatica > Flashcards

Crystal arthropathies and polymyalgia rheumatica Flashcards

1
Q

What are crystal deposition diseases characterised by?

A

Deposition of mineralised material within joints and peri-articular tissue

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2
Q

What are common mineralised material deposited in joints to cause crystal deposition diseases?

A

Monosodium urate = gout
Calcium pyrophosphate dehydrate (CPPD) = pseudogout
Basic calcium phosphate hydroxy-apatite (BCP) = calcific periarthritis/tendonitis

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3
Q

What crystal deposition causes gout?

A

Monosodium urate

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4
Q

What crystal deposition causes pseudogout?

A

Calcium pyrophosphate dihydrate (CPPD)

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5
Q

What crystal deposition causes calcific periarthritis/tendonitis?

A

Basic calcium phosphate hydroxy-apatite (BCP)

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6
Q

What are tophi?

A

Massive accumulations of uric acid

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7
Q

What is uric acid an end product of metabolism-wise?

A

Purine metabolism

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8
Q

What does too much uric acid cause?

A

Hyperuricemia

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9
Q

What can increased production of purines cause?

A

Hyperuricemia -> gout attack

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10
Q

What are the two main ways the hyperuricemia can occur?

A

Overproduction of uric acid

Under excretion of uric acid

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11
Q

How can there be an overproduction which causes hyperuricemia?

A 
Malignancy
Severe exfoliative psoriasis
Drugs e.g. ethanol, cytotoxic drugs
Inborn errors of metabolism
HGPRT deficiency
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12
Q

What is more common: over production of uric acid or under excretion?

A

Under excretion

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13
Q

What can cause under excretion of uric acid?

A 
Renal impairment
Hypertension
Hypothyroidism
Drugs e.g. alcohol, low dose aspirin, diuretics, cyclosporin
Exercise, starvation, dehydration
Lead poisoning
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14
Q

What is Lesch Nyhan syndrome?

A

HGPRT deficiency

X-linked recessive

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15
Q

What does HGPRT deficiency cause?

A

Causes a build-up of uric acid in all body fluids

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16
Q

What are the signs/symptoms of Lesch Nyhan syndrome?

A 
Intellectual disability
Aggressive/impulsive behaviour
Self mutilation
Gout
Renal disease
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17
Q

Which sex is affected more by gout?

A

Men

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18
Q

What are the signs/symptoms of gout?

A 
Monoarthritis
Tophi
Inflammatory arthritis
Warm, tender, painful joints
Pyrexia
?Kidney stones
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19
Q

Where is the most common place for crystal deposition in gout?

A

The MTP joint in the foot

20
Q

What are the investigations for gout?

A

Serum urate
WCC, ESR
Synovial fluid = arthrocentesis
XR

21
Q

What is arthrocentesis?

A

Synovial fluid aspiration

22
Q

What can be seen in synovial fluid in gout?

A

Needle-shaped, negatively birefringent monosodium urate crystals

23
Q

What is the management of gout?

A

Acute flare:
NSAIDs
Colchicine
Steroids

24
Q

When does the 1st attack of hyperuricemia need treated?

A
  • single attack polyarticular gout
  • tophaceous gout
  • urate calculi
  • renal insufficiency
25
Q

When does the 2nd attack of hyperuricemia need treated?

A

If 2nd attack within 1yr

26
Q

When should you not treat hyperuricemia?

A

Asymptomatic

27
Q

What are uric acid lowering medications?

A

Xanthine oxidase inhibitor = allopurinol
Febuxostat
Uricosuric agents (sulphinpyrazone, probenecid, benzbromarone)
Canakinumab

28
Q

What is the main drug for preventing uric acid synthesis?

A

Allopurinol

29
Q

What are the rules for lowering uric acid levels?

A

Wait until acute attack settled
Use prophylactic NSAIDs or low dose colchicine/steroids until rate level normal
Adjust allopurinol dose according to renal function

30
Q

What are CVS and lifestyle factors that could be addressed for gout?

A 
Alcohol
Dietary excess
Fasting/severe dieting
Hydration
Exercise
Smoking
BP
31
Q

Which group is pseudogout seen most commonly in?

A

Elderly females

32
Q

What is aetiology of pseudogout?

A

Idiopathic
Familial
Metabolic

33
Q

What are triggers for pseudogout?

A

Trauma

Intercurrent illness

34
Q

What is chonedrocalcinosis?

A

Calcification in hyaline and/or fibrocartilage

35
Q

What type of crystals are found in the joint aspiration of pseudogout?

A

CPPD crystals

Pyrophosphate crystals

36
Q

What type of birefringent are the crystals in pseudogout?

A

Positively birefringent

37
Q

What is the manangement for pseudogout?

A

NSAIDs

Intra-articular injection steroids

38
Q

What are the investigations for pseudogout?

A

Joint aspirations

XR

39
Q

What is polymyalgia rheumatica?

A

A common inflammatory condition which causes bilateral pain, typically worse in the morning and associated with morning stiffness, in the shoulder, neck and pelvic girdle

40
Q

What other conditions are associated with polymyalgia rheumatica?

A

Giant cell arteritis (GCA)
High ESR
Anemia

41
Q

What is the age on onset of polymyalgia rheumatica normally?

A

> 70yrs

42
Q

Which sex is more common affected by polymyalgia rheumatica?

A

Females

43
Q

What is the ESR in polymyalgia rheumatica?

A

> 45 often 100

44
Q

What are other signs/symptoms associated with polymyalgia rheumatica?

A 
Anaemia
Malaise
Weight loss
Fever
Depresion
Arthralgia/synovitis
45
Q

How do you make a diagnosis of polymyalgia rheumatica?

A 
Compatible history
>50yrs
ESR >50
Dramatic steroid response
Non specific diagnostic test
46
Q

What are differentials for polymyalgia rheumatica?

A 
Myalgic onset inflammatory joint disease
Underlying malignancy
Inflammatory muscle disease
Hypo/hyperthyroidism
Bilateral shoulder capsulitis
Fibromyalgia
47
Q

What is the treatment for polymyalgia rheumatica?

A

Prednisolone

Bone prophylaxis

MSK (17 decks)

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