Crystal Associated Arthritis Flashcards
What is it?
Deposition of crystals in joints and tissues
Over time inflammatory changes leads to development of chronic arthritis with features of OA
What are risk factors for it?
Male Aged 20-60 Hyper/hypothyroidism Previous joint surgery/trauma Inherited genetic disorder High protein diet- red meat High alcohol intake esp beer Metabolic syndrome e.g. hyperlipidaemia, DM, HTN Renal failure Drugs- aspirin, diuretics, chemotherapy
What is gout?
Deposition of urate crystals in soft tissues and joints causing pathological acute inflammatory reaction
What are common sites of gout?
Crystals deposit in peripheral connective tissues in and around joints
Base of big toe
Wrists
Base of thumb
What are symptoms of gout?
Rapid onset severe pain- wakes the patient up
Maximum severity in 2-6hrs
Tender, swollen, erythematous
Accompanying fever/malaise/confusion
Lasts 5-14 days before resolving
Attack can be precipitated by excess food/alcohol/dehydration
Recurrent attacks on same joint can lead to secondary OA due to cartilage destruction
What is found on examination in gout?
Monoarticular Swollen hot joint Erythema Decreased range of movement Fever may be present DDx- septic arthritis
What investigations are needed in gout?
Bloods
- FBC- WCC raised
- U&Es- renal involvement
- CRP- raised
- Serum uric acid- helps to determine treatment efficacy
Joint aspiration
- gram staining to rule out SA
- MCS
- polarised light microscopy
- -needle shaped crystals and negative birefringent
Joint XR
- assess degree of joint damage
- are in early disease
- may have joint erosis
What is the management of acute episode of gout?
Patient education- rest, decrease alcohol and red meat intake
Stop offending gent e.g. aspirin
Ice pack
Paracetamol
High dose NSAID, low does roal colchicine/corticosteroid injection
-colchicine is used if renal patient
-early steroid injection can stop acute attack
Safety net
What is used in long term management of gout?
1) Allopurinol
- indicated if
- -recurrent attacks
- -chronic gout
- -evidence of bone or joint damage
- -renal disease
- -very high uric acid levels
- reduces uric acid levels- want it in lower half of normal
- measure uric acid levels monthly and increase dose in 100mg increments until target range achieved
- SE
- -induce acute gout
- skin rash
- bone marrow suppression
2) Sulfinpyrazone
- increases urine excretion of uric acid
- Contraindicated in renal stones and failure
What is pseudogout?
Calcium pyrophosphate crystal deposition in hyaline/fibrocartilage of joints causing chondrocalcinosis (gross calcium deposition in articular cartilage)
What are risk factors for pseudogout?
Idiopathic FH Metabolic disease- hyperparathyroidism, hypophosphatasia Increased age Women
What are symptoms of pseudo gout?
Typically in knee or wrist
Hot, swollen, stiff joint
Must exclude septic arthritis
What are investigations for pseudogout?
Same for gout
Polarised light microscopy- rhomboid shaped crystals, positive bifringenet
XR may show chondrocalcinosis
What is the management of pseudogout?
Similar to gout
Responds well to joint aspiration
What is calcific periarthritis?
Deposition of calcium in various tissues
Periarticular tissues- tendons causing calcific tendonitis
Hyaline cartilage- associated with more severe OA
