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ANKI Rheumatology > Crystal arthropathy > Flashcards

Crystal arthropathy Flashcards

1
Q

What is crystal arthropathy?

A

group of joint disorders caused by deposits of crystals in joints and soft tissues around them

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2
Q

What are the most common types of crystal arthropathy?

A
  1. Gout

2. Calcium pyrophosphate deposition (CPPD) -Pseudo-gout

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3
Q

What is acute CPPD?

A

acute monoarthropathy usually larger joints in elderly, usually spontaneous

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4
Q

What is chronic CPPD?

A

inflammatory RA-like symmetrical polyarthritis and synovitis

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5
Q

What are RF for CPPD?

A
  1. Old age
  2. Hyperparatyroidism
  3. Haemochromtosis
  4. Hypophosphatameia
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6
Q

What does synovial fluid analysis show in CPPD?

A

weakly positively birefringent rhomboid-shaped crystals

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7
Q

What would X ray show with CPPD?

A

and soft tissue calcium deposition on X ray

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8
Q

How do you manage CPPD?

A
  1. Mono/oligoarticular disease: Intra-articular corticosteroids +/- paracetamol
  2. Polyarticular disease: NSAIDs or colchicine +/- paracetamol and systemic corticosteroids if 1st line fails/contraindicated
  3. Chronic/recurrent: joint replacement
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9
Q

What is normal epid for gout?

A
  1. 3-6% men
  2. 1-2% women
  3. Rare in premenopausal women
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10
Q

What are RF for gout?

A
  1. Older age
  2. Male sex
  3. Use of drug e.g. aspirin, ciclosporin , tacrolimus or pyrazinmaide
  4. Alcohol
  5. Genetic
  6. Chemo/cancer
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11
Q

What are causes of gout?

A
  1. Hyperuricaemia (either from reduced urate excretion or excess urate production)
  2. Precipitated by trauma, infection.
  3. Monosodium urate
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12
Q

What are symptoms of GOUT?

A
  1. Acute onset of severe joint pain
  2. Swelling
  3. Effusion
    Warmth
  4. Eythema
  5. Tenderness of involved joint
  6. Tophi
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13
Q

What joints are affected in gout?

A

Feet joint: first metatasophalangeal, tarsometatrsal and ankle joints

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14
Q

How many joints are affected in gout?

A

Few affected joints usually monoarticular or <4 joints

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15
Q

What are possible DDx for gout?

A
  1. Pseudogout
  2. Septic arthritis: EXCLUDE
  3. Trauma
  4. RA
  5. Reactive arthritis
  6. Psoriatic arthritis
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16
Q

What investigation is used in gout?

A

arthrocentesis with synovial fluid analysis

17
Q

What would synovial fluid be like in Gout?

A

strongly negative birefringent needle-shaped crystals under polarised lights

18
Q

What is the 1st line management for acute gout?

A
  1. NSAIDs e.g. naproxen 500mg twice daily 10-14 days
  2. Corticosteroid e.g., prednisolone 20-40mg once daily
  3. Colchicine 1.2mg
19
Q

What is 2nd line management of Gout?

A

IL-1 inhibitor e.g. anakinra

20
Q

What is management for recurrent gout?

A
  • 1st line: allopurinol 100mg daily + NSAIDs
  • 2nd line: febuxostat 40-80mg daily
  • 3rd line: probenecid or sulfinpyrazone
  • 4th line: pegloticase
21
Q

What are possible complications of gout?

A
  1. Joint destruction
  2. Kidney disease
  3. Urolithiasis
  4. Nephrolithiasis
  5. Acute uric acid nephropathy
22
Q

What is gout a RF for?

A

mortality from cardiovascular and renal disease

23
Q

What are symptoms of pseudogout?

A
  1. Acute monoarthritis
  2. Large joints – knee
  3. Polyarticular (chronic)
24
Q

What is pseudogout caused by?

A
  1. Precipitated by trauma, illness.
  2. Calcium pyrophosphate.
  3. Idiopathic
  4. hyperPTH, hypoPO4, hypoMg, metabolic
25
Q

What are additional XR changes in psuedogout?

A
  1. Linear, stippled radio-opaque deposits in fibro cartilage OR hyaline cartilage
  2. Calcified tendons
  3. Subchondral cysts
26
Q

What other investigations can be used in psudeogout?

A
  1. Serum calcium –> normal or elevated

2. Serum parathyroid hormone –> normal or elevated

27
Q

What can lead to hyperuricaemia in gout?

A
  1. Increased intake of uric acid in gout often due to high purine diet, alcohol
  2. Increased production can be malignancy-related (tumour lysis syndrome)
  3. Decreased excretion is usually the result of diuretic medication
28
Q

What would aspirate show in gout?

A
  1. turbid, yellow, low viscosity fluid. Raised WCC (neutrophils)
  2. Needle shaped, -vely birefringent crystals
29
Q

What would bloods show in gout?

A
  1. elevated WCC
  2. CRP
  3. uric acid (4-6 weeks later)
30
Q

What would XR show in gout?

A

“rat bite” erosions

31
Q

What do you give for acute attack of gout?

A
  1. NSAIDs +/- PPI
  2. Colchicine (anti-mitotic)
  3. Corticosteroids
32
Q

What do you give for prophylaxis in gout?

A
  1. Allopurinol
  2. febuxostat
  3. probenecid
33
Q

How does colchine MOA work?

A
  • Binds to tubulins & prevents assembly of microtubules –> no WBC migration –> less inflammation
  • Idea of prevention in gout is to minimise uric acid levels (so adjusting diet, alcohol etc. is also recommended).

ANKI Rheumatology (14 decks)

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