Crystal deposition diseases

Question 1

Gout?

Answer 1

hyperuricemia is not gout
typically follows years of asymptomatic hyperuricemia
serum urate increased by alcohol, height, body weight, age, blood pressure BUN, creatinine

Question 2

Associated conditions?

Answer 2

obestiy, ethanol, diabetes mellitus, hypertrigylcermia, hypertension, hypthyroidism, atherosclerosis, metabolic syndrome, pregnancy, acute illness, dehyrdation

Question 3

Negative associations?

Answer 3

Rheumatologic arthritis
SLE
ankylosing spondylitis

Question 4

Clinical gout?

Answer 4

asymptomatic hyperuricemia
acute gout–intercurrent period—acute gout (repeat the cycle)
chronic gout

Question 5

presentation of gout?

Answer 5

alecranon bursa, big toe

Question 6

Pathology of gout?

Answer 6

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

Question 7

tophi?

Answer 7

can look rheumatoid nodules

Question 8

radiographic findings?

Answer 8

erosions, crystals replace bone, gouty deposits

Question 9

Primary hyperuricemia causes?

Answer 9

Underexcretion 90% Idiopathic

Overproduction 10%, HGPRT def, PRPP sythetase Superactivity, G6PD def, Fructose 1 Phosphate aldolase def

Question 10

Secondary Hyperuricemia?

Answer 10

which occurs as a result of a drug effect or is a secondary to another disease

Question 11

Glycogen storage disorders?

Answer 11

type I, III, V, VII

cause of overproduction

Question 12

Known mechanisms of under excretion?

Answer 12

inhibition of tubular urate secreation

enhanced tubular reabsorption

Question 13

Combined overproduction and underexcretion?

Answer 13

glucose 6 phos def

fructose 1 phosphate aldolase def

Question 14

Indications for treatment for gout?

Answer 14

acute gout, tophi, uric acid stones, uric acid nephropathy, intersitial nephritis

Question 15

Treatment goals for gout?

Answer 15

stop acute attacks, resolve tophi, prevent joint damage, decrease uric acid below 6.0

Question 16

Treatment acute gout?

Answer 16

colchinine, indomethacin

Question 17

Calcium pyrophosphate?

Answer 17

common name pseudogout
occurs exclusively in and around joints
may be asymptomatic or cause disease

Question 18

Acute clinical presentation?

Answer 18

similar to gout

may have fever, leukocytosis, elevated ESR

Question 19

Chronic clinical presentation?

Answer 19

similar to OA
symmetrical
mainly in knees, wrists, hips
isolated patellofemoral disease

Question 20

Clinical presentations gout?

Answer 20

polyarticular may mimic RA
oligoarticular usually elderly
pyrophosphate arthropathy (early mimics osteoarthritis, late charcot joint)
precocious osteoarthritis

Question 21

Chondrocalcinosis?

Answer 21

pseudogout
OA 50%
Gout 25%
Asymptomatic 20%

Question 22

Epidemiology of Chondrocalcinosis?

Answer 22

Herediary autosomal dominant 
post traumatic
sporadic rare under age 40
osteochondredysplasia
secondary to metabolic disease

Question 23

Radiographic findings?

Answer 23

Chondrocalcinosis
Crowned Dens (neck pain due to crytals deposits surrounding dens)
Cord compression
wrap around patella
Erosive OA

Question 24

Diagnosis of Chondrocalcinosis?

Answer 24

crystals in joint (definite)
other calcium crystals in joint (probable)
possible for xray findings, typical joint distribution, history

Question 25

Calcium pyrophostphate?

Answer 25

swollen, tender, red hot joint
crystals (parallelogram)

vs Gout (needle shape)

Question 26

Pathology of Calcium pyrophostphate?

Answer 26

normal serum phosphate
normal phosphate excretion
elevated levels of inorganic phosphate in synoival fluid
Cause- NTPPHase

Question 27

Treatment Calcium pyrophostphate?

Answer 27

NSAIDs, Colchicine, Streroids, Physical Therapy, Surgery, Joint injections

Question 28

Appetite like crystals?

Answer 28

Caronate substituted apatite
Octacalcium Phosphate (OCP)
Tricalcium phosphate (TCP)
Dicalcium phosphate dihyrdate (brushite)

Question 29

Apatite-like disease?

Answer 29

bursitis, tendonitis, arthritis, renal failure, epiphyseal dysplasia, destructive OA, cyrstals not visible on microscopy, Alizaren Red-stain red, bon Koss-stain black, precise ID requires xray diffraction