Crystal arthropathy Flashcards
Gout
crystal arthropathy associated with high blood uric acid levels
What kind of crystals gout?
monosodium urate
What are gouty tophi?
subcutaneous deposits of uric acid affecting small joints and connective tissue of hands, elbows and ears
DIPJ
How does gout present?
Single acute, hot, swollen and painful joint
Important differential diagnosis - gout
septic arthritis
Risk factors - gout
male obesity high purine diet eg meat alcohol diuretics CVD or CKD FH
Typical joints - gout
base of big toe - MTPJ
wrists
base of thumb
Diagnosis of gout
clinically
aspirating fluid from joint
joint aspiration in gout will show..
no bacterial growth
needle shaped crystals
negative birefringent
monosodium urate crystal
x-ray findings gout
lytic lesions in bone
punched out erosions
Managing acute flare gout
NSAIDs
colchicine
steroids
who is colchicine used for?
patients inappropriate for NSAIDs eg renal impairment
Prophyaxis of gout
allopurinol
lifestyle changes
Allopurinol
xanthine oxidase inhibitor
reduces uric acid level
What is pseudogout?
crystal arthropathy caused by crystal deposition in joints
crystals in pseudogout
calcium pyrophosphate
presentation of pseudogout
older adult
hot, swollen, stiff, painful knee
joints commonly affected - pseudogout
knee
shoulders, wrists and hips
diagnosing pseudogout
aspirate synovial fluid
x-ray
aspirated fluid - pseudogout
calcium pyrophosphate crystals
positive birefringent of polarised light
no bacterial growth
pathopneumonic x-ray change - pseudogout
chondrocalcinosis
thin white line in middle of joint space caused by calcium deposition
x-ray changes - pseudogout
loss of joint space
osteophytes
subarticular sclerosis
subchondral cysts
managing pseudogout
NSAIDs colchicine joint aspiration steroid injections oral steroids joint washout
