Crystal arthropathies - week 5 PBL Flashcards
What is the presentation of gout?
Red, hot swollen joint
Big toe, carpometacarpal joint of thumb
Gouty Tophi in elbow, DIP, ear pinna
What are the risk factors of gout?
Large Alcohol consumption
High purines (red meat and shellfish)
Current heart and kidney problems
What are the X-ray features of gout?
Normal joint space
Rat bite erosions
Overhanging edges
Sclerotic edges
Investigations of gout?
Synovial Joint aspiration
Microscopy, stain and culture
Elevated neutrophils
Elevated urea in bloods
Positive synovial joint investigation of gout?
Yellow Needle shaped, negatively birefringement under polarised light microscopy
Pathophysiology of gout?
Deposition of mono sodium phosphate crystals
Hyperuricemia
Acute Management of gout?
Acute: NSAIDS or colchicine (used for pt who cannot take NSAIDs)
Steroids last line
Side effect of Colchicine ?
Diarrhoea
Chronic treatment of gout?
Allopurinol (xanthine oxidase inhibitor), rash is side effect. Cannot start in acute attack.
Febuxostat(non purine based xanthine oxidase inhibitor)
Lifestyle changes
Presentation of pseudo gout?
Elderly pt
Hot and swollen joint
Knee but also other large joints
Risk factors of pseudogout ?
Joint trauma
Hypercalcaemia
Hyper parathyroid is (causes high Ca2+)
Hypo thyroidism
Features of pseudogout on X-ray?
Chondrocalcinosis (calcium deposition in joint space)
Investigations for pseudogout?
Synovial joint aspiration
Blue Rhomboid shaped positively birefringement crystals under polarised miscroscopy
Cause of pseudogout?
Deposition of Calcium pyrophosphate dihydrate crystals
Management for Pseudogout?
Symptomatic relief
NSAIDs for pain
Bandage joint to reduce swelling
