Crystal arthropathy Flashcards
What is gout?
Gout is a syndrome characterised by: hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis; tophi around the joints and possible joint destruction; renal glomerular, tubular and interstitial disease; and uric acid urolithiasis.
What is pseudogout?
Calcium pyrophosphate deposition (CPPD) is associated with both acute and chronic arthritis. Acute CPP crystal arthritis is an acute inflammatory arthritis of one or more joints.
Happens to older people
What are the risk factors of gout?
older age
male sex
menopausal status
consumption of meat, seafood, alcohol
use of diuretics
use of ciclosporin (cyclosporine) or tacrolimus
use of pyrazinamide
use of aspirin
genetic susceptibility
high cell turnover state
What are the risk factors of pseudogout?
> Age > Injury > Hyperparathyroidism > Haemochromatosis > FHx > Hypomagnesaemia > Hypophosphatasia
What is the epidemiology of gout?
The prevalence in the western world is about 1%, with a male to female ratio of 7:1 to 9:1; in the UK
What is the epidemiology of pseudogout?
In the UK, the prevalence of cartilage calcification associated with knee pain was 4.5%, with a strong age association.
What are the signs and symptoms of gout and pseudogout?
> rapid onset severe pain
> Joint stiffness
> Foot joint distribution
> Few joints affected
> Swelling and joint effusion
> Tenderness
> Tophi
> Erythema/ warm
Pseudo: Painful joints, osteoarthritis joints involved, suddenly worse osteo
What are the investigations you would do for pseudogout?
> Athrocentesis with synovial fluid analysis (positively birefringent rhomboid-shaped crystals under polarised light)
> X Rays affected joint (linear, stippled radio-opaque deposits in the cartilage)
> Bloods- calcium, PTH, iron [Normal or elev.], magnesium, alk phos [Normal or decreased]
What are the investigations you would do for gout?
> Arthrocentesis with analysis- High WCC and negative birefringent needle shaped crystals
