Crystal deposition diseases Flashcards
Gout?
hyperuricemia is not gout
typically follows years of asymptomatic hyperuricemia
serum urate increased by alcohol, height, body weight, age, blood pressure BUN, creatinine
Associated conditions?
obestiy, ethanol, diabetes mellitus, hypertrigylcermia, hypertension, hypthyroidism, atherosclerosis, metabolic syndrome, pregnancy, acute illness, dehyrdation
Negative associations?
Rheumatologic arthritis
SLE
ankylosing spondylitis
Clinical gout?
asymptomatic hyperuricemia
acute gout–intercurrent period—acute gout (repeat the cycle)
chronic gout
presentation of gout?
alecranon bursa, big toe
Pathology of gout?
monosodium urate cyrstals are formed when the bodies capacity to store uric acid is suppressed
uric acid is a byproduct of purine metabolism
serum saturation 6.7 mg/dl
tophi?
can look rheumatoid nodules
radiographic findings?
erosions, crystals replace bone, gouty deposits
Primary hyperuricemia causes?
Underexcretion 90% Idiopathic
Overproduction 10%, HGPRT def, PRPP sythetase Superactivity, G6PD def, Fructose 1 Phosphate aldolase def
Secondary Hyperuricemia?
which occurs as a result of a drug effect or is a secondary to another disease
Glycogen storage disorders?
type I, III, V, VII
cause of overproduction
Known mechanisms of under excretion?
inhibition of tubular urate secreation
enhanced tubular reabsorption
Combined overproduction and underexcretion?
glucose 6 phos def
fructose 1 phosphate aldolase def
Indications for treatment for gout?
acute gout, tophi, uric acid stones, uric acid nephropathy, intersitial nephritis
Treatment goals for gout?
stop acute attacks, resolve tophi, prevent joint damage, decrease uric acid below 6.0
Treatment acute gout?
colchinine, indomethacin
Calcium pyrophosphate?
common name pseudogout
occurs exclusively in and around joints
may be asymptomatic or cause disease
Acute clinical presentation?
similar to gout
may have fever, leukocytosis, elevated ESR
Chronic clinical presentation?
similar to OA
symmetrical
mainly in knees, wrists, hips
isolated patellofemoral disease
Clinical presentations gout?
polyarticular may mimic RA
oligoarticular usually elderly
pyrophosphate arthropathy (early mimics osteoarthritis, late charcot joint)
precocious osteoarthritis
Chondrocalcinosis?
pseudogout
OA 50%
Gout 25%
Asymptomatic 20%
Epidemiology of Chondrocalcinosis?
Herediary autosomal dominant post traumatic sporadic rare under age 40 osteochondredysplasia secondary to metabolic disease
Radiographic findings?
Chondrocalcinosis Crowned Dens (neck pain due to crytals deposits surrounding dens) Cord compression wrap around patella Erosive OA
Diagnosis of Chondrocalcinosis?
crystals in joint (definite)
other calcium crystals in joint (probable)
possible for xray findings, typical joint distribution, history
