Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal + Rheumatology > Crystal Arthropathy > Flashcards

Crystal Arthropathy Flashcards

1
Q

What is crystal arthropathy?

A

Characterised by deposition of mineralised material within joints and peri-articular tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Desribe purine metabolism

A

Endogenous production of uric acid from degradation of purines contributes to 2/3rds of the body urate pool, the remainder being dietary in origin

Of the uric acid produced daily, majority is excreted via the kidney and the remainder is eliminated into the biliary tract and subsequently converted by colonic bacterial uricase to allanotin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can cause the overproduction of purines?

A

Malignancy, due to faster turnover of cells and more DNA broken down

Severe exfoliative psoriasis, causing increased cell breakdown

Drugs

Inborn errors of metabolism

HGPRT deficiency/Lesch Nyan Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drugs can cause oveproduction of purines?

A

Ethanol, as high in purine

Cytotoxic drugs as more cell breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Lesch Nyan Syndrome?

A

Enzymatic defect in which purine bases are degraded and excreted as uric acid causing accelerated synthesis of purines to compensate, resulting in overproduction of uric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What mode of inheritence is Lesch Nyan Syndrome?

A

X linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does Lesch Nyan syndrome present?

A

Intellectual disability, gout, renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can cause underexcretion of uric acid?

A

Renal Impairment

  • Majority of Gout is due to hyperuricaemia resulting from reduced efficiency of renal urate clearance

Hypertension

Hypothyroidism

Exercise, starvation, dehydration

Lead poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drugs can cause underexcretion of uric acid?

A

Alcohol

Low dose aspirin

Diuretics

  • Perhaps as you are flushing water out, the concentration of uric acid is increased?

Cyclosporine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is gout?

A

Inflammatory disease characterised by deposits of monosodium urate crystals within joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What site does gout usually affect?

A

Most commonly affects proximal meta-tarsal joint of 1st digit

But can also affect knees, wrist, elbows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What sex does gout most commonly affect?

A

M>F, perhaps as oestrogen increases uric acid excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give risk factors for gout

A

DM, as decreased ability to excrete uric acid

Obesity

High BP and cholesterol/Ischaemic heart disease

Alcohol consumption

Diuretic

Dehydration

Ageing, due to decreased renal function

Shellfish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does gout present?

A

Symptoms occur at a single joint and onset is usually overnight. An untreated attack can last 2-3 weeks

Severe heat

Pain

Swelling

Tophi

Podagra

Joint deformity in chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are tophi?

A

Hard nodules over bony prominence in chronic gout due to massive accumulation of uric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is podagara?

A

Gout of big toe

17
Q

What investigations are used in gout diagnosis?

A

Aspirate joint

  • Culture to rule out infection
  • Polarised Light microscopy to visualize crystals

Uric acid levels not very useful as many flares present with normal levels originally

>CRP, ESR

Imaging

  • Peri-articular erosions in chronic gout
18
Q

What do gout crystals look like under microscopy?

A

Needle shaped crystals

Negatively birefringent

19
Q

How is an acute flare of gout managed?

A

NSAIDS, to decrease pain and swelling

Colchicine, used if NSAIDs are contraindicated ie peptic ulcer

Occasionally steroids if both are contraindicated

20
Q

What lifestyle management is used in gout?

A

Reduce alcohol

Weight loss

21
Q

What pharmacological methods are used in chronic gout management?

A

Xanthine oxidase inhibitor

  • Xanthine oxidase is an enzyme involved in breaking down of purine

Febuxostat

  • Nonpurine selective xanthine oxidase inhibiton
  • Used as second line when allopurinol is not tolerated
22
Q

Give an example of a Xanthine Oxidase Inhibitor

A

Allopurinol

23
Q

Why do you have to be careful with Xanthine Oxidase Inhibitors?

A

In acute phase can precipitate an episode of gout, however if already prescribed can continue in current dose

24
Q

What should be coprescribed with allopurinol?

A

NSAID or colchicine cover if experiencing an acute flare of gout

25
Q

What medication should allopurinol be avoided with?

A

Azathioprine, as risk of bone marrow suppression

26
Q

How is the 1st attack of gout managed?

A

Does not need treatment unless single attack of polyarticular gout, torphaceous gout, urate calculi or renal insufficiency

27
Q

How is 2nd attack of gout managed?

A

Treat if 2nd attack within 1 year

Wait until acute attack has settled before attempting to reduce urate level, use prophylactic NSAIDS or low dose colchicine/steroids until urate level is normal

28
Q

When is colchicine used instead of NSAIDS for gout management?

A

Used when NSAIDS are contraindicated due to GI bleeding history or comorbidities

29
Q

Give side effects of colchicine

A

Diarrhoea

N&V

30
Q

Give complications of gout

A

Arthritis

  • Repeated gouty attacks can lead to chronic gout/permanent monosodium urate crystals in joints

Kidney stones made of uric acid

31
Q

When is prophylactic treatment of gout used?

A

Certain malignancies

32
Q

What is pseudogout?

A

Inflammatory disease characterised by deposits of calcium pyrophosphate dihydrate within larger joints

33
Q

What causes pseudogout?

A

Elderly females

Idiopathic

Associated conditions

  • Hyperparathyroidism
  • Acromegaly
  • Haemochromatosis
  • Wilson’s disease

Flare Triggers

  • Trauma
  • Intercurrent illness
34
Q

How does pseudogout present?

A

Pain mainly in the knee

Can be asymptomatic

Swelling

Warmth

Tenderness

35
Q

What investigations are used in pseudogout diagnosis?

A

Aspirate Joint

  • Visualise crystals with polarised light microscopy

X-Ray

  • Chondrocalcinosis/Ca deposits
36
Q

What do pseudogout crystals look like under microscopy?

A

Rhomboid crystals

Positive birefringent

37
Q

How is pseudogout managed?

A

NSAIDS for acute treatment

Intraarticular corticosteroid injections, use if NSAIDS does not control pain

No prophylactic therapies

Musculoskeletal + Rheumatology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions