Crystal Associated Arthritis Flashcards
CA Pathogenesis
Crystals form in tissues when their constituents exceed their solubility threshold
(Usually avoided by the presence of inhibitors)
Favourable factors:
- decreased temperature
- decreased pH
- crystal nucleators
Crystals are disturbed-> trauma, illness, surgery, partial treatment-> shed in to synovial fluid/bursa-> inflammation
Calcium pyrophosphat dehydrate crystals CPD epidemiology
Deposited at enthesis and hyaline cartilage -> chondrocalcinosis Most commonly knees 30% >70y Females
CPD risk factors
Commonly idiopathic Age OA Metabolic -haemachromatosis -Wilsons -hypothyroid -hypoparathyroid Dehydration Infection Acromegaly Gout
CPD clinical features
Incidental findings on X Ray Pseudo-gout -severe pain -swelling -tenderness -erythema -fever
Chronic:
- gradual onset
- pain
- stiffness
- decreased ROM
- OA and synovitis
CPD investigations
Joint aspiration-> polarising light microscopy
X Ray
-chondrocalcinosis
-OA
CPD management
Analgesia
Aspiration and corticosteroid injection
No prophylaxis
Basic calcium phosphate BCD clinical features
Commonly a symptomatic 3-4% of pop Soft tissues Pain Erythema Swelling Fever
Supraspinatus tendon
Middle age
Spontaneous trauma
BCD investigations
Aspiration
X-ray
-tendon associate calcinosis
BCD management
Analgesia
Aspiration and steroid
Gout epidemiology
Mono sodium irate mononuclate 1-4% Men 7% of >75y Most common inflammatory arthritis 40-50y Rare before menopause
Gout risk factors
>0.36 Age Male Obesity Renal insufficiency Diuretics Hypertension Hyperglycaemia Metabolic syndrome
Gout aetiology
Uris acid is the end product of purine metabolism
2/3 renal you excreted
Hyperuriciemia + genetic renal defect
Acute gout clinical features
Rapid onset mono arthritis Developed over night MTPJ joint 50% Sever pain Shiney, warm, erythematous skin Fever Resolves spontaneously in 1-2w
Chronic gout clinical features
Uncontrolled hyperuricaemia Recurrent attacks Asymetrical poly arthritis Tophi -helix -bursa -tendon sheaths -peri articular 10% renal colic
Gout investigations
Joint aspiration and polarising light -> strong negative bifringence Raised CRP and ESR X-ray -calcified soft tissue swellings -punched out erosions with sclerotic regions -cartilages erosion USS -crystal depositions BP and renal function Asses CV risk
Acute gout management
Rest
Analgesia
Joint aspiration and injection
Avoid aspirin
Chronic gout management
Reduce SUA to bellow 0.3 Don't start till acute episode subsides 1) Avoid/discontinue diuretics Gradual wt loss Increased fluid intake Decrease alcohol and fructose
2) allopurinol -> inhibitor
100mg and NSAIDS
Measure monthly
3) febuxostat-> inhibitor
Sulfinpyrazone
Avoid shellfish and red meat
