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Rheumatology > Crystal Athropathy > Flashcards

Crystal Athropathy Flashcards

1
Q

What is the mineral that forms gout

A

Monosodium urate

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2
Q

What is the mineral that forms pseudogout

A

Calcium pyrophosphate dihydrate (CPPD

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3
Q

What is the mineral that forms calcific periarthritis/tendonitis

A

Basic calcium phosphate hydroxy-apatite (BCP

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4
Q

What is gout

A

Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.

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5
Q

What happens to uric acid that is produced in the body?

A

Of the uric acid produced daily, the majority (∼ 70%) is excreted via the kidney and the remainder is eliminated into the biliary tract and subsequently converted by colonic bacterial uricase to allantoin.

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6
Q

What is usually the underlying cause of gout

A

reduced efficiency of renal urate clearance

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7
Q

What is the aetiology of gout

A

Alcohol
Genetic
- Lesch Nyan Syndrome

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8
Q

What is Lesch Nyan Syndrome

A

Lesch Nyhan syndrome is a condition characterized by neurological and behavioral abnormalities and the overproduction of uric acid in the body. It occurs almost exclusively in males. Signs and symptoms may include inflammatory arthritis (gout), kidney stones, bladder stones, and moderate cognitive disability.

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9
Q

How can you categorise the pathophysiology of gout

A

Overproduction

Underproduction

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10
Q

What are causes of over production of uric acid

A 
¥	Malignancy e.g lymphoproliferative, tumour lysis syndrome
¥	Severe exfoliative psoriasis
¥	Drugs e.g. ethanol, cytotoxic drugs
¥	Inborn errors of metabolism
¥	HGPRT deficiency
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11
Q

What are causes of under production of uric acid

A

Renal impairment

Hypertension

Hypothyroidism

Drugs e.g. alcohol, low dose aspirin, diuretics, cyclosporin

Exercise, starvation, dehydration

Lead poisoning (rare)

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12
Q

How does alcohol increases the risk of gout

A

Some alcoholic drinks are rich in purines, notably beer which contains guanosine. Alcohol is thought to increase the risk of gout because the metabolism of ethanol to acetyl CoA leads to adenine nucleotide degradation, resulting in increased formation of adenosine monophosphate, a precursor of uric acid.

Alcohol also raises the lactic acid level in blood, which inhibits uric acid excretion.

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13
Q

What is the epidemiology of gout

A

Men have higher urate levels than women and an increased prevalence of gout at all ages, though less pronounced in older age

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14
Q

Why do men get more gout than females

A

Oestrogen has a uricosuric effect, making gout very rare in younger women. However, after the menopause, urate levels rise and gout becomes increasingly prevalent.

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15
Q

What are classic symptoms of gout

A 
Classically appears overnight
Classically on big toe  (first mtp) 
Usually last 5-7 days 
Erythema of skin 
Very painful

Can get accumuulations of uric acid

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16
Q

What are accumuulations of uric acid under the skin called?

A

Tophus

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17
Q

What are the investigations for gout

A

NEED TO EXCLUDE SEPTIC ARTHRITIS

Aspirate joint

  • Look for crytals (needle shaped negatively birofingent crystals)
  • Look for sepsis (send away for culture and microscopy)
  • S
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18
Q

What is management of an acute flare of gout

A
  • NSAIDs
  • Colchicine
  • Steroids
    I/A, I/M, oral
19
Q

Why do you need to be careful with colchicine

A

Careful with renal problems

20
Q

When do you treat a first a gout attack

A

Single attack of polyarticular gout

Tophaceous gout

Urate calculi

Renal insufficiency

21
Q

When do you treat a second gout attack

A

Treat if 2nd attack within 1 yr

22
Q

How to you prprophylactically treat GOUT

A

lower uric acid

Xanthine oxidase inhibitor e.g. Allopurinol
Febuxostat

  • Metabolised in liver not kidney (good for renal impairment)
    Uricosuric agents (very difficult to get hold of)
  • sulphinpyrazone, probenecid, benzbromarone,
    Canakinumab
23
Q

What are CI for Febuxostat

A

Be careful with CVD history as increased risk of CVD death when taken

Metabolised in liver not kidney (good for renal impairment)

24
Q

What are the rules for lowering uric acid levels (x4)

A

Wait until the acute attack has settled before attempting to reduce the urate level

Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal

Adjust allopurinol dose according to renal function

Address cardiovascular and lifestyle factors

25
Q

What is pseudo gout

A

Pseudogout (or “false gout”) is a form of arthritis that results from deposits of calcium pyrophosphate crystals (its medical term is calcium pyrophosphate dihydrate crystal deposition disease, or CPPD

26
Q

Where does pseudo gout normally affect

A

It commonly affects the knees and wrists.

27
Q

What is the epidemiology of pseudogout

A

Older woman

28
Q

What is the aetiology of pseudogout

A
  • Idiopathic, familial, metabolic

Triggers
- Trauma, Intercurrent illness

29
Q

What investigations should you do for pseudo gout

A

X-ray

Aspirate

30
Q

What can you see on an Xray for pseudogout

A

Chondrocalcinosis

31
Q

What is Chondrocalcinosis

A

White thin line in middle of joint space

Its DIAGNOSTIC for pseudo gout

32
Q

What do you look for in the aspirate of pseudo gout

A

Can see rhomboid shaped crystals. Positively birofringent

33
Q

What is management for pseudo gout

A

NSAIDs
I/A steroids
colchicine

34
Q

What can be done prophylactically for pseudo gout

A

There are no prophylactic therapies

35
Q

What is first line treatment for gout

A

NSAIDS

36
Q

What is second line treatment for gout

A

Colcichine

37
Q

What is third line treatment for gout

A

Steroids

38
Q

What is Polymyalgia Rheumatica (PMR)

A

Polymyalgia rheumatica is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.

39
Q

What is epidimiolgoy of Polymyalgia Rheumatica (PMR)

A

Rare < 50y usually > 70y

F:M 2:1

40
Q

What are signs/symptoms of Polymyalgia Rheumatica (PMR)

A

SUDDEN onset of shoulder +/- pelvic girdle STIFFNESS (in morning)

ESR usually > 45 often 100

Pain (worse with movement)

Anaemia

Malaise ; Weight loss ; fever; depression

Arthralgia / synovitis (rarely)

SHOULDN’T GET WEAKER

41
Q

What are investigations for Polymyalgia Rheumatica (PMR)

A

NO SPECIFIC BLOOD TEST
Compatible history

Dramatic steroid response

42
Q

What is the treatment for Polymyalgia Rheumatica (PMR)

A

Prednisolone 15mg per day initially
18-24 mth course (long time)

Bone prophylaxis

43
Q

What are differentials for Polymyalgia Rheumatica (PMR)

A

Myalgic onset Inflammatory joint disease (rheumatoid arthritis)
Underlying malignancy (common differential)
- e.g Multiple myeloma, lung cancer
Inflammatory muscle disease
Hypo/ hyperthyroidism
Bilateral shoulder capsulitis
Fibromyalgia

44
Q

When are differentials considered for Polymyalgia Rheumatica (PMR)

A

These are considered when the there is no improvement after steroid therapy

Rheumatology (11 decks)

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