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Year 3 MSK (JK) > Crystal arthropathy > Flashcards

Crystal arthropathy Flashcards

1
Q

How are crystal deposition diseases characterised?

A

deposition of mineralised material within joints and peri-articular tissue

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2
Q

3 common crystal deposition diseases

A

monosodium urate -> gout
calcium PYROPHOSPHATE dihydrate –> pseudogout
basic calcium phosphate hydroxy-apatite –> calcific periarthritis/tendonitis

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3
Q

Gout - appearance

A 
1st MTP joint
acute onset - over night 
red, shiny, acutely painful 
over bony prominences 
white flecks of crystal
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4
Q

how long does an attack of gout last?

A

7 to 10 days

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5
Q

Tophus

A

massive accumulations of URIC ACID

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6
Q

source of endogenous uric acid

A

purine degeneration and diet

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7
Q

link between uric acid and gout

A

hyperuricaemia leads to gout

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8
Q

overproduction causes of hyperuricaemia

A 
malignancy 
drugs eg cytotoxic, ethanol 
severe exfoliative psoriasis 
inborn error of metabolism 
HGPRT enzyme deficiency
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9
Q

underexcretion causes of hyperuricaemia

A 
renal impairment 
hypertension 
hypothyroidism 
drugs eg alcohol, diuretics
exercise, starvation, dehydration 
lead poisoning
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10
Q

Cause of Lesch Nyan syndrome

A

HGPRT deficiency

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11
Q

inheritance of Lesch nyan syndrome

A

x-linked recessive

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12
Q

Symptoms of lesch nyan syndrome

A 
gout 
renal disease 
self mutilation 
aggressive and impulsive behaviour 
intellectual disability
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13
Q

risk factors for gout

A

Henry 8th - HTN, diabetes, obese, cholesterol
sportsman - dehydrated
alcohol
diuretics

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14
Q

Prevalence of gout in UK

A

elderly men
oestrogen helps excrete uric acid
ageing eg diuretics, decreased renal function

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15
Q

Investigations for gout

A

high uric acid blood test? chronic?

ASPIRATION - crystals and exclude infection

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16
Q

managing an acute flare of gout

A

NSAIDS
colchicine
steroids I/A,I/M,oral

17
Q

Side effect of colchicine

A

diarrhoea

18
Q

When do you treat hyperuricaemia in the 1st attack of gout?

A

urate calculi
trophaceous gout
single attack of polyarticular gout
renal insufficiency

19
Q

Treating hyperuricaemia in gout

A

2nd attack in a year

prophylactically prior to treating certain malignancies

20
Q

Do you treat asymptomatic hyperuricaemia?

A

NO

21
Q

lowering uric acid medications

A

allopurinol
febuxostat
sulphinpyrazone
canakinumab

22
Q

How does allopurinol work to lower uric acid?

A

xanthine oxidase inhibitor

23
Q

3 rules for lowering uric acid levels

A

wait until acute settled before introducing allopurinol
use prophylactic NSAIDS or low dose steroids/colchicine until urate level normal
adjust allopurinol depending on renal function

24
Q

Pseudogout affects what joint?

A

KNEE

25
Q

Who does pseudogout affect?

A

elderly females

idiopathic, familial, metabolic

26
Q

triggers for pseudogout

A

trauma

intercurrent illness

27
Q

Crystals in pseudogout

A

pyrophosphate

28
Q

Management of pseudogout

A

NSAIDS

I/A steroid

29
Q

What condition does polymyalgia rheumatica have a strong link to?

A

GCA

30
Q

Symptoms of polymyalgia rheumatica

A

sudden onset of shoulder and/or pelvic girdle stiffness
anaemia
peripheral arthralgia/synovitis
malaise, weight loss, fever and depression

31
Q

Who does polymyalgia rheumatica affect?

A

Females 2: male

32
Q

Is ESR raised in polymyalgia rheumatica ?

A

yes

33
Q

Diagnosis of polymyalgia rheumatica

A

compatible history
age >50 and ESR >50
dramatic response to steroids in 24-48 hours

34
Q

diff diagnosis for polymyalgia rheumatica

A 
polymyositis 
hyper/hypothyroidism 
fibromyalgia 
bilateral shoulder capsulitis 
underlying malignancy?
35
Q

Treating polymyalgia rheumatica

A

prednisolone 15mg/day initially
18-24 month course
DEXA scan and bone prophylaxis

Year 3 MSK (JK) (30 decks)

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