Crystal arthropathy Flashcards
What is crystal arthropathy?
group of joint disorders caused by deposits of crystals in joints and soft tissues around them
What are the most common types of crystal arthropathy?
- Gout
2. Calcium pyrophosphate deposition (CPPD) -Pseudo-gout
What is acute CPPD?
acute monoarthropathy usually larger joints in elderly, usually spontaneous
What is chronic CPPD?
inflammatory RA-like symmetrical polyarthritis and synovitis
What are RF for CPPD?
- Old age
- Hyperparatyroidism
- Haemochromtosis
- Hypophosphatameia
What does synovial fluid analysis show in CPPD?
weakly positively birefringent rhomboid-shaped crystals
What would X ray show with CPPD?
and soft tissue calcium deposition on X ray
How do you manage CPPD?
- Mono/oligoarticular disease: Intra-articular corticosteroids +/- paracetamol
- Polyarticular disease: NSAIDs or colchicine +/- paracetamol and systemic corticosteroids if 1st line fails/contraindicated
- Chronic/recurrent: joint replacement
What is normal epid for gout?
- 3-6% men
- 1-2% women
- Rare in premenopausal women
What are RF for gout?
- Older age
- Male sex
- Use of drug e.g. aspirin, ciclosporin , tacrolimus or pyrazinmaide
- Alcohol
- Genetic
- Chemo/cancer
What are causes of gout?
- Hyperuricaemia (either from reduced urate excretion or excess urate production)
- Precipitated by trauma, infection.
- Monosodium urate
What are symptoms of GOUT?
- Acute onset of severe joint pain
- Swelling
- Effusion
Warmth - Eythema
- Tenderness of involved joint
- Tophi
What joints are affected in gout?
Feet joint: first metatasophalangeal, tarsometatrsal and ankle joints
How many joints are affected in gout?
Few affected joints usually monoarticular or <4 joints
What are possible DDx for gout?
- Pseudogout
- Septic arthritis: EXCLUDE
- Trauma
- RA
- Reactive arthritis
- Psoriatic arthritis