Crystal Disease - Told Flashcards
2 most common crystals
monosodium urate
calcium pyrophosphate dihydrate
episodic attack
think crystals
rare crystals
cholesterol
monoclonal proteins
calcium phosphate hydroxyapatite
calcium oxalate
caicific tendonitis
with calcium phosphate hydroxyapatite
does not react on polarized light**
oxalosis
kidney stops eliminating calcium oxalate from body
-get nephrolithiasis
get retinal sx as well
terminal tuft calcification
with psoriatic arthritis and oxylosis only**
multiple myeloma
monoclonal protein crystals in joints
S100A4 antibody**
MMP and apoptosis - matrix destruction of joint
YIPA
yellow in parallel - monosodium urate
BIPA
blue in parallel - calcium pyrophosphate
hyperuricemia/gout epidemiology
increased with age and body mass
middle age men
incidence of gout in females approaches that of males after menopause
risk with hyperuricemia
cardiovascular disease**
hot joint
with gout
decreased renal excretion
majority of hyperuricemia causes
impaired renal function dehydration acidosis low dose salicylates diuretic pyrazinamide cyclosporine levodopa ethambutol nicotinic acid hypothyroidism
podagra
first attack of gout
cytotoxic drugs
increase urate production - leads to hyperuricemia
best predictor of gout attack
sudden change in uric acid level
tophi
chronic urate overload
negative birefringement
monosodium urate crystals
clinical course of gout
1 - asymptomatic hyperuricemia
2 - intermittent arthritis
3 - chronic arthritis and acute exacerbations
tophi
in gout
not just subQ
-can get into and destroy joint
positive birefringement
BIPA
calcium pyrophosphate
pseudogout
negative birefringement
YIPA
monosodium urate
gout
indication for lowering of urate
tophi disease with erosions
uric acid nephrolithiasis
recurrent attack despite prophylaxis
acute gout CI
allopurinol
but do not stop during attack if already taking**
chondrocalcinosis
pseudogout
calcium pyrophosphate deposition disease
CPPD - pseudogout
associated with pseudogout
hyperPTH hypoT hemochromatosis wilsons disease OA
management of crystal disease
arhrocentesis - analyze crystals
NSAIDs
corticosteroids
colchicine - prophylaxis
uric acid lowering agents
allopurinol
febuxostate
uricosuric agents
not during acute attacks
acute tx of gout
indomethacin
tx of asymptomatic hyperuricemia
no tx - check diuretic use and ASA use and niacin use
colchicine
can be crap shoot
purine free diet
only decrease uric acid by 1%mg
medication is best treatment**
keratoconjunctivitis sicca
sjogrens disease
dry eyes and dry mouth
primary sjogrens
women 40-60yo
exocrine gland dysfunction
RA and other auto-Abs common
secondary sjogrens
with other autoimmune diseases
diagnosis of sjogrens
4 of 6 criteria - sensitive 93% and specific 94%
1 - autoimmune exocrinopathy
2 - ocular sx
3 - oral sx
4 - ocular signs - schirmers or rose bengal
5 - characteristic histopath features
6 - salivary testing autoAbs - RF, SS-A, SS-B
nucleolar anti Ro SSA
more specific than speckled**
labs with sjogrens
anemia, leukopenia, eosinophilia
hypergammaglobulinemia
RA positive 70%
ANA positive 95%
sialectasis
cystic dilation of duct
with sjogrens
parotid gland enlargement
in sjogrens
schirmers test
positive if cannot get tears
in sjogrens
wetting of 5mm/5min filter paper
rose bengal staining
indicates inflammation and irritation of conjunctival layer of eyes
positive in sjogrens
nonspecific interstitial pneumonia and xyerotrachea
low tracheobronchial secretions - in sjogrens
tx of sjogrens
tx is symptoms
artifical tears - methyl cellulose cyclosporine drops oral hygiene and hydration pilocarpine cevimeline
careful watch for lymphoma**
