crystal arthropathy Flashcards
type of crystal deposition in gout
monosodium urate
type of crystal deposition in pseudogout
calcium pyrophosphate dihydrate CPPD
type of crystal deposition in calcific periarthritis/ tendonitis
basic calcium phosphate hydroxy-apatite BCP
hyperuricaemia: overproduction causes
malignancy
severe exfolative psoriasis
ethanol
errors of metabolism
HGPRT deficiency
hyperuricaemia: under excretion causes
renal impairment
hypertension
hypothyroidism
alcohol
aspirin
diuretics
cyclosporin
excersive, starvation, dehydration
lead poisoning
lesch nyan syndrome
HGPRT deficiency- involved in purine recycling
X linked recessive
intellectual disability
aggressive and impulsive behaviour
gout
renal disease
investigations for gout
aspirate joint (dont usually need to do first MTp as its so classically gout)
if needle shaped crystals under microscopy- gout
management of gout
NSAID, colchicine (can cause diarrhoea), steroids in acute flare
treat chronic if 2nd attack within 1 year, polyarticular gout, tophi, urate calculi, renal insufficiency
-with allopurinol or febuxostat 2nd line
wait until acute attack has settled before attempting to reduce the urate level
adjust allopurinol dose according to renal function - 100mg per day and increase up until urate normal
lifestyle factors
pseudogout
older adult with a hot, swollen, stiff, painful knee
elderly females
erratic flares
idiopathic, familial, metabolic
trauma, intercurrent illness
investigations for pseudogout
aspirate
rhomboid shaped crystals
xray
management pseudogout
no prophylaxis
NSAIDs , colchicine
IA steroids
Polymyalgia rheumatica symptoms
sudden onset of shoulder and pelvic girdle stiffness
usually 70 years plus
females more
ESR usually >45 often 100
anaemia
malaise
weight loss
depression
fever
synovitis uncommonly
diagnosis polymyalgia rheufuckoffica
compatible history
age >50
ESR>50 use a centrifuge
dramatic steroid response!!! within 24/48 hours
treatment PMR
prednisolone 15mg per day initially
18-24 month course
bone prophylaxis- DEXA scan
ask about headcahes etc as temporal artritis!
what must be excluded in hot painful swollen joint
septic arthritis so aspirate must show no bacterial growth
