Brainscape's Knowledge GenomeTM

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


See full index

Year 3 MSK > Crystal Arthropathy & Polymyalgia rheumatica > Flashcards

Crystal Arthropathy & Polymyalgia rheumatica Flashcards

1
Q

Define Crystal Arthropathies?

A

Any arthropathy involving deposition of mineralised material in joints or periarticular tissue
I.e. Gout & Pseudogout

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

What is deposited in joints in Gout?

A

Monosodium Urate, crystals of Uric Acid

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

Describe the physiological passage of urate?

A

2/3rd plasma urate comes from purine breakdown
1/3rd comes from diet

Its then cleared mostly by the kidneys and some by the biliary tract

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

What are some causes of over-production of Urate?

A
  • Myeloproliferative/Lymphoproliferative disorders
  • Severe Exfoliative Psoriasis
  • Drugs e.g. Alcohol
  • HGPRT deficiency (Lesch-Nyhan syndrome)
  • Inborn Metabolic errors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some causes of under-excretion of urate?

A 
Renal Impairment (main cause for gout)
HYpertension
Hypothyroidism
Drugs e.g. Diuretics, aspirin, alcohol & cyclosporin
Lead poisoning
Exercise, starvation or dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is HGPRT deficiency also known as?

A

Lesch-Nyhan Syndrome

An X linked recessive disorder (only affects boys)

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

How does Lesch Nyan Syndrome present?

A 
Intelectual disability
Aggresive/Impulsive behaviour
Self-mutilation (lip biting etc)
Gout
Renal Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does Gout present?

A

Swelling/nodules on joints
Red, hot and painful oints

Most commonly in the toe

The overlying skin may peel

May see white chalkish material under the skin/breaking through

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

Who gets gout?

A

Older men mostly.

Women increase in incidence a lot as they age

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

Why do older women get so much more gout than younger women?

A

Oestrogen is Uricosuric (i.e. helps excretion) so post-menopausal women get lots of gout

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

What are the risk factors for gout?

A
  • Male
  • Hypertension
  • Alcohol
  • Obesity
  • High Cholesterol
  • Smoking
  • Diabetes
  • Purine rich diet - meat & shellfish
  • CVS or kidney disease
  • Diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we test someone to confirm gout?

A

Needle aspiration of the swollen joint:

  • Cultures to rule out septic arthritis
  • Polarising Microcospy to see the crystals & so confirm gout
  • Negatively birefringent needle-shaped crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What test is useful for managing chronic hyperuricaemia (gout)?

A

Uric Acid blood test

Not useful acutely but good for monitoring chronic levels and effectiveness of treatment

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

How can we manage an acute flare up of gout?

A

NSAIDs (Colchicine if NSAIDs not tolerated)

Steroids (Oral/IM/IA)

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

How do we manage long-term Hyperuricaemia? (ie what is the long term/prophylactic treatment for gout)

A

1st line - Xanthine Oxidase Inhibitor (Allopurinol)

2nd line - Uricosuric agents e.g. sulphinpyrazone or probenecid

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

What should you do when starting or increasing allopurinol?

A

Give prophylactic NSAIDs or Colchicine/Steroids.

As allopurinol can actually trigger gout

17
Q

When would we treat hyperuricaemia?

A

Only if:

  • Tophaeceous (i.e. large crystals)
  • Polyarticular
  • Urate Calculi
  • Renal Insufficiency
  • 2nd attack in 1 yr

Never treat if asymptomatic

18
Q

What crystals are deposited in pseudogout?

A

Calcium Pyrophosphate Dihydrate (CPPD)

19
Q

Who gets Pseudogout?

A

Elderly women, mostly in the knee

20
Q

What causes Pseudogout?

What are risk factors?

A

Trauma in an elderly person…

Can happen in younger people with intercurrent illness such as:

  • hyperparathyroidism
  • haemachromatosis
  • low magnesium, low phosphate
  • acromegaly, Wilson’s disease
21
Q

How does pseudogout present?

A

Acutely swollen joint usually after a fall

22
Q

How do we test for pseudogout?

A

Needle aspiration…
- weakly positively birefringent rhomboid-shaped crystals!

Xray…
- chondrocalcinosis

23
Q

how to treat pseudogout?

A

NSAIDs

IA steroids

24
Q

What is Polymyalgia Rheumatica?

A

Condition involving stiffness and inflammation in the shoulder and pelvis

Often associated with GCA

25
Q

How does PR present?

What blood results may be found?

A

Fairly rapid (<1 month) onset of:

  • aching & morning stiffness of proximal limb muscles
  • arthralgia in shoulders & pelvis
  • fever
  • lethargy, malaise, weight loss, depression
  • +/- big fkn temple artery thing (GCA)

Bloods:

  • raised ESR
  • anaemia
26
Q

Who gets PR?

A

2F:1M

Usually >70yrs

27
Q

How do we diagnose PR?

A

Patient:
>50yrs
>50 ESR
REsponds DRAMATICALLY to Steroids

28
Q

DDX for PR?

A 
Malignancy (Multiple myeloma or lung cancer)
Hypo/hyperthyroidism
Inflammatory muscle disease
Bilateral Shoulder Capsulitis
Fibromyalgia
29
Q

How do we treat PR?

A 
CCS (eg prednisolone) for 18-24 months
Bone prophylaxis (Ca, Vit D & Bisphosphonates)

Year 3 MSK (42 decks)

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