Crystal Arthropathy Flashcards
What joint deposit is seen in gout?
Monosodium urate
What joint deposit is seen in pseudogout?
Calcium pyrophosphate dihydrate
What joint deposit is seen in calcific arthritis/tendonitis?
Basic calcium phosphate hydroxy-apatite
What is the origin of uric acid?
Breakdown of purines
Diet
Where is uric acid excreted?
70% at kidney
Rest at biliary tree
What are the causes of hyperuricaemia due to overproduction?
Malignancy Severe exfoliative psoriasis Drugs Errors of metabolism HGPRT deficiency
What are the causes of hyperuricaemia due to undersecretion?
Renal impairment Hypertension Hypothyroidism Drugs Exercise Dehydration
What is Lesch Nyan syndrome?
HGPRT deficiency X-linked recessive Aggressive behaviour Gout Renal disease
How is an acute flare of gout managed?
NSAIDs
Colchicine
Steroids
How is hyperuricaemia treated?
Only treat if GOUT found
Do not treat asymptomatic hyperuricaemia
How is uric acid lowered?
Allopurinol
Febuxostat
Uricosuric agents
What are the roles for lowering uric acid levels?
Wait until attack has settled
Prophylactic NSAIDs until normal
How is Gout managed?
Lower Uric acid levels
Treat Gout
Address CV/lifestyle factors
What lifestyle factors can be changed for gout?
Weight loss Diabetes HTN Smoking High purine foods Alcohol
What is pseudogout?
Knee gout
Seen in elderly females
Erratic flares triggered by trauma, illness
How is pseudogout managed?
NSAIDs
I/A steroids
What is polymyalgia rheumatica?
Inflammatory condition in the elderly with a relationship to giant cell arthritis and high ESR anaemia
How does polymyalgia rheumatica present?
Sudden onset shoulder/pelvic girdle stiffness 50 - 70yrs Female x2 Elevated ESR Anaemia Malaise, fever, weight loss Arthralgia
How is polymyalgia rheumatica diagnosed?
History
Age >50
ESR >50
Dramatic response to steroids
What is the differential diagnosis of polymyalgia rheumatica?
Myalgic onset inflammatory joint disease Malignancy Inflammatory muscle disease Thyroid disease Bilateral shoulder capsulitis Fibromyalgia
How is polymyalgia rheumatica treated?
Prednisolone
