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MSK > crystal arthropathy > Flashcards

crystal arthropathy Flashcards

1
Q

what are the crystals present in gout, pseudo gout and tendonitis ?

A

gout - monosodium urate
pseudo gout - CPPD
tendonitis - BCP

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2
Q

what causes overproduction of uric acid ?

A 
malignancy 
severe exfoliative psoriasis
drugs - cytotoxic drugs, alcohol
inborn metabolism errors
HGPRT deficiency
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3
Q

what causes under excretion of uric acid ?

A 
renal impairment
hypertension
hypothyroidism
drugs - alcohol, aspirin, diuretics, cyclosporin
exercise, starvation, dehydration
lead poisoning
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4
Q

what is Lesch Nyan syndrome and what does it cause ?

A

X-linked recessive intellectual disability - HGPRT deficiency

aggressive and impulsive
self mutilation
gout
renal disease

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5
Q

how is gout investigated ?

A

arthrocentesis - needle shaped crystals under polarised light

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6
Q

how do you treat an acute flat of gout ?

A

NSAID
colchicine
steroids

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7
Q

do you treat asymptomatic hyperuricaemia ?

A

NAW

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8
Q

in what circumastances would you treat hyperuricaemia ?

A

single attack of polyarticular gout
tophaceous gout
urate calculi
renal insufficiency

treat if 2nd attack in 1 year

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9
Q

what drugs are used to lower uric acid ?

A

allopurinol - xanthine oxidase inhibitor
febuxostat
uricosuric agents - sulphinpyrazone, probenecid, benzbromarone
canakinumab

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10
Q

what are the rules for lowering uric acid levels ?

A

wait until acute attack has settled before attempting to reduce rate levels
use prophylactic NSAIDs or low does colchicine/steroids until rate level normal
adjust allopurinol dose according to renal function

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11
Q

what other factors have to be managed in gout ?

A

address cardiovascular and lifestyle factors

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12
Q

what is pseudogout ?

A

elderly females
usually knee
erratic flare ups
triggered by trauma or intercurrent illness

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13
Q

how do you manage pseudo gout ?

A

NSAIDs

I/A steroids

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14
Q

what is polymyalgia rheumatica ?

A

inflammatory condition of the elderly, F>M

linked to GCA

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15
Q

what are clinical features of polymyalgia rheumatica ?

A

SUDDEN onset shoulder +/- pelvic girdle stiffness
anaemia
malaise, weight loss, fever, depression
arthralgia/synovitis occasionally

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16
Q

how is polymyalgia rheumatica diagnosed ?

A

compatible history
age > 50
ESR>50
dramatic steroid response

17
Q

what are differential diagnoses of polymyalgia rheumatica ?

A 
myalgic onset inflammatory joint disease
underlying malignancy
inflammatory muscle disease
hypo/hpyerthryroidsm
bilateral shoulder capsulitis
fibromyalgia
18
Q

how do you treat polymyalgia rheumatica ?

A

prednisolone 15mg/day
18-24 month course
bone prophylaxis

MSK (29 decks)

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