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Musculoskeletal > Crystal Arthropathies & Soft Tissue Disease > Flashcards

Crystal Arthropathies & Soft Tissue Disease Flashcards

1
Q

What is gout?

A

Inflammation in the joint triggered by uric acid crystals

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2
Q

What three factors therefore cause gout?

A
  • Excess consumption
  • Over production
  • Under excretion
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3
Q

At what level do uric acid crystals become insoluble?

A

> 0.42 mmol/l

=> Hyperuricaemia

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4
Q

Why is gout rare in females before menopause?

A

Because oestrogen promotes excretion of uric acid

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5
Q

How does acute gout usually present?

A

monoarthropathy
- 1st MTP > ankle > knee

Abrupt onset, often overnight

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6
Q

How long does acute gout usually take to settle?

A

Settles in about 10 days without treatment

Settles in about 3 days with treatment

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7
Q

DO patients with gout always have an abnormal uric acid level?

A

NO

this may be normal during an acute attack

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8
Q

What is chronic tophinous gout?

A

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

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9
Q

What investigations are useful when you are suspecting gout?

A

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

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10
Q

What pharmacological treatments are used for acute gout?

A

NSAIDs
Colchicine
Steriods

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11
Q

What pharmacological treatments are used for prophylaxis of gout?

A

Allopurinol
Febuxostat (if become intolerant)
Start 2-4 weeks after acute attack
Require cover with NSAID

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12
Q

What compound is deposited in pseudo-gout?

A

calcium pyrophosphate

and Calcium hydroxyappatite crystals

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13
Q

Where does pseudo-gout most commonly occur?

A

Affects fibrocartilage - knees, wrists, ankles

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14
Q

Are inflammatory markers usually raised in pseudo-gout?

A

Yes

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15
Q

What treatments are used for pseudo-gout?

A

NSAIDS
Colchicine
Steroids
Rehydration

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16
Q

What occurs when hydroxyapatite deposits in the shoulder?

A
  • Release of collagenases, serine proteinases and IL-1

- Acute and rapid deterioration

17
Q

What group is most at risk of hydroxyapatite deposits in their shoulder?

A

Females, 50-60 years

18
Q

What treatments are used when hydroxyapatite deposits in the shoulder?

A

NSAIDs

Intra-articular steroid injection

Physiotherapy

Partial or total arthroplasty

19
Q

What is soft tissue rheumatism?

A

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.

20
Q

If soft tissue rheumatism is not confined to a specific site which other process should you consider?

A

Fibromyalgia

21
Q

Where is the most common area for soft tissue pain?

A

shoulder

22
Q

Apart from the shoulder, where else can be affected in soft tissue rheumatism?

A

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

23
Q

What investigations can be done to diagnose soft tissue rheumatism?

A

Tests = usually unnecessary

X-ray - calcific tendonitis
MRI if fails to settle

24
Q

What treatment is used for soft tissue rheuamtism

A 
Pain control
Rest and Ice compressions
PT
Steroid injections
Surgery
25
Q

In what cases is joint hyper-mobility syndrome more common?

A

Females»Males

Rare genetic syndromes
e.g. Marfan’s syndrome, Ehlers Danlos syndrome

Usually presents in childhood or 3rd decade

26
Q

How is joint hyper-mobility syndrome diagnosed?

A

MODIFIED BEIGHTON SCORE

1 point for each criteria
>4/9 = hypermobility

27
Q

How is joint hyper-mobility syndrome treated?

A

physiotherapy

28
Q

How do patients with joiint hypermobility syndrome usually present?

A

Presents with:

  • arthralgia
  • Premature osteoarthritis
  • Investigations normal

Musculoskeletal (27 decks)

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