Crystal Arthropathies & Soft Tissue Disease Flashcards
What is gout?
Inflammation in the joint triggered by uric acid crystals
What three factors therefore cause gout?
- Excess consumption
- Over production
- Under excretion
At what level do uric acid crystals become insoluble?
> 0.42 mmol/l
=> Hyperuricaemia
Why is gout rare in females before menopause?
Because oestrogen promotes excretion of uric acid
How does acute gout usually present?
monoarthropathy
- 1st MTP > ankle > knee
Abrupt onset, often overnight
How long does acute gout usually take to settle?
Settles in about 10 days without treatment
Settles in about 3 days with treatment
DO patients with gout always have an abnormal uric acid level?
NO
this may be normal during an acute attack
What is chronic tophinous gout?
Chronic joint inflammation
(May get acute attacks)
Often diuretic associated
Tophi - present in fingers for example
deposits look like they are bursting out of skin
What investigations are useful when you are suspecting gout?
Raised inflammatory markers
Serum uric acid raised (may be normal during acute attack)
Synovial fluid - polarising microscopy shows needle shaped negatively birefringent crystals
Renal impairment (may be cause or effect)
Xrays
What pharmacological treatments are used for acute gout?
NSAIDs
Colchicine
Steriods
What pharmacological treatments are used for prophylaxis of gout?
Allopurinol
Febuxostat (if become intolerant)
Start 2-4 weeks after acute attack
Require cover with NSAID
What compound is deposited in pseudo-gout?
calcium pyrophosphate
and Calcium hydroxyappatite crystals
Where does pseudo-gout most commonly occur?
Affects fibrocartilage - knees, wrists, ankles
Are inflammatory markers usually raised in pseudo-gout?
Yes
What treatments are used for pseudo-gout?
NSAIDS
Colchicine
Steroids
Rehydration
What occurs when hydroxyapatite deposits in the shoulder?
- Release of collagenases, serine proteinases and IL-1
- Acute and rapid deterioration
What group is most at risk of hydroxyapatite deposits in their shoulder?
Females, 50-60 years
What treatments are used when hydroxyapatite deposits in the shoulder?
NSAIDs
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty
What is soft tissue rheumatism?
pain caused by inflammation/damage to
ligaments/tendons/muscles or nerve near a joint rather than bone/cartilage
confined to a specific site e.g. shoulder, wrist etc.
If soft tissue rheumatism is not confined to a specific site which other process should you consider?
Fibromyalgia
Where is the most common area for soft tissue pain?
shoulder
Apart from the shoulder, where else can be affected in soft tissue rheumatism?
Elbow – medial and lateral epicondylitis
- Cubital tunnel syndrome
Wrist – De-Quervains tenosynovitis
- Carpal tunnel syndrome
Pelvis – Trochanteric, Iliopsoas, Ischiogluteal
bursitis and Stress enthesopathies
Foot – Plantar fascitis
What investigations can be done to diagnose soft tissue rheumatism?
Tests = usually unnecessary
X-ray - calcific tendonitis
MRI if fails to settle
What treatment is used for soft tissue rheuamtism
Pain control Rest and Ice compressions PT Steroid injections Surgery
In what cases is joint hyper-mobility syndrome more common?
Females»Males
Rare genetic syndromes
e.g. Marfan’s syndrome, Ehlers Danlos syndrome
Usually presents in childhood or 3rd decade
How is joint hyper-mobility syndrome diagnosed?
MODIFIED BEIGHTON SCORE
1 point for each criteria
>4/9 = hypermobility
How is joint hyper-mobility syndrome treated?
physiotherapy
How do patients with joiint hypermobility syndrome usually present?
Presents with:
- arthralgia
- Premature osteoarthritis
- Investigations normal
