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MSK > Crystal Arthropathy > Flashcards

Crystal Arthropathy Flashcards

1
Q

Define Crystal Arthropathies?

A

Any arthropathy involving deposition of mineralised material in joints or periarticular tissue
I.e. Gout &Pseudogout

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2
Q

What is deposited in joints in Gout?

A

Monosodium Urate, crystals of Uric Acid

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3
Q

Describe the physiological passage of urate?

A

2/3rd plasma urate comes from purine breakdown
1/3rd comes from diet

Its then cleared mostly by the kidneys and some by the biliary tract by being converted into allantoin

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4
Q

What are some causes of over-production of Urate?

A
  • Malignancy
  • Severe Exfoliative Psoriasis
  • Drugs e.g. Alcohol
  • HGPRT deficiency
  • Inborn Metabolic errors
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5
Q

What are some causes of under-excretion of urate?

A
  • Renal Impairment (main cause for gout)
  • HYpertension
  • Hypothyroidism
  • Drugs e.g. Aspirin, alcohol, diuretics, cyclosporin
  • Lead poisoning
  • Exercise, starvation or dehydration
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6
Q

What is HGPRT deficiency also known as?

A

Lesch Nyan Syndrome

An X linked recessive disorder

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7
Q

How does Lesch Nyanred Syndrome present?

A

1- Hyperuricemia: renal stones/ disease/ GOUT
2- Motor delay:
• Intellectual disability
• Fits/ dystonia
3- aggressive and impulsive behaviour: self-mutilation

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8
Q

How does Gout present?

A

Swelling/nodules on joints
Red, hot and painful oints

Most commonly in the toe

The overlying skin may peel

May see white chalkish material under the skin/breaking through

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9
Q

Who gets gout?

A

Older men mostly.

Women increase in incidence a lot as they age

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10
Q

Why do older women get so much more gout than younger women?

A

Oestrogen is Uricosuric (i.e. helps excretion) so post-menopausal women get lots of gout

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11
Q

What are the risk factors for gout?

A
  • Hypertension
  • Alcohol
  • Obesity
  • High Cholesterol
  • Smoking
  • Diabetes
  • Shellfish (purine rich)
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12
Q

How do we test someone to confirm gout?

A

Needle aspiration of the swollen joint:

  • Cultures to rule out septic arthritis
  • Polarising Microcospy to see the crystals & so confirm gout
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13
Q

What test is useful for managing chronic disease?

A

Uric Acid blood test

Not useful acutely but good for monitoring chronic levels and effectiveness of treatment

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14
Q

How can we manage an acute flare up of gout?

A

NSAIDs (Colchicine if NSAIDs not tolerated)

Steroids (Oral/IM/IA)

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15
Q

How do we manage long-term Hyperuricaemia?

A

1st line - Xanthine Oxidase Inhibitor (Allopurinol)/ febuxostat if not tollerated
2nd line - Uricosuric agents e.g. sulphinpyrazone or probenecid

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16
Q

What should you do when starting or increasing allopurinol?

A
  • Wait until the acute attack has settled before attempting to reduce the urate level
  • Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
  • Adjust allopurinol dose according to renal function
17
Q

When would we treat hyperuricaemia?

A

Only if:

  • Tophaeceous (i.e. large crystals)
  • Polyarticular
  • Urate Calculi
  • Renal Insufficiency
  • 2nd attack in 1 yr

Never treat if asymptomatic

18
Q

What crystals are deposited in pseudogout?

A

Calcium Pyrophosphate Dihydrate (CPPD)

19
Q

Who gets Pseudogout?

A

Elderly women, mostly in the knee

20
Q

What causes Pseudogout?

A

Triggered by trauma e.g. a fall or an interurrent illness

21
Q

How does pseudogout present?

A

Acutely swollen joint usually after a fall

22
Q

How do we test for pseudogout?

A

X-ray can be useful to see chondrocalcinosis in the joint

Needle aspiration to see CPPD crystals confirms q

23
Q

how to treat pseudogout?

A

NSAIDs
IA steroids
No prophylactic treatment

24
Q

What is Polymyalgia Rheumatica?

A

Condition involving stiffness and inflammation in the shoulder and pelvis

Often associated with GCA

25
Q

How does PR present?

A

-Sudden onset shoulder +/- pelvic girdle stiffness
-Anaemia
-Malaise, WEight loss
Fever
Depression
~Arthralgia

26
Q

Who gets PR?

A

2F:1M

Usually >70yrs

27
Q

How do we diagnose PR?

A

Patient:
>50yrs
>50 ESR
REsponds DRAMATICALLY to Steroids

28
Q

DDX for PR?

A 
Malignancy (Multiple myeloma or lung cancer)
Hypo/hyperthyroidism
Inflammatory muscle disease
Bilateral Shoulder Capsulitis
Fibromyalgia
29
Q

How do we treat PR?

A 
Predinosole/ CCS for 18-24 months
Bone prophylaxis (Ca, Vit D & Bisphosphonates)
30
Q

Management Lesch Nyan syndrome?

A
  • Good hydration: prevents renal stones- increases urine flow
  • Allopurinol prevents urate stones
  • Protective measures to protent self-mutilation

MSK (40 decks)

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