Crystal Induced Flashcards
What is included in crystal induced arthritis?
Gout
Calcium pyrophosphate dihydrate deposition disease
Osteoarthritis
Who gets gout?
<65 = men >65 = men and women
What is the MCC of inflammatory arthritis in men >40?
Gout
What is gout?
Not an autoimmune
Heterogenous metabolic disorder associated with hyperuricemia cause by:
1. Underexcretion of uric acid
2. Overproduction of uric acid
What is uric acid?
A product of purine metabolism
MC cause of gout>?
Underexcretion of uric acid
Acute inflammation gout gets better in?
10-14 days
Chronic inflammatory gout is:
Response leading to continued crystal deposition (tophi)
What are acute intermittent gout and chronic gouty arthritis?
Acute intermittent gout»_space; chroinic gouty arthritis
Takes 10 yrs
Joints become uncomfortable and swollen
What affects urate overproduction and underexcretion?
ETOH G6PD Fructose 1-PAD HCTZ Niacin ASA
Clinical manifestations of gout?
Nephrolithiasis (radiolucent)
Tophaceous gout
Skin desquamation
Podagra
Diagnostic levels for gout”?
Hyperuricema
- uric acid >/= 6.8 mg/dL
Uric acid nephrolitthiasis
- uric acid >13 mg/dL
X rays for gout?
“Rat bite” lesions (late sign)
Clinical diagnosis for gout?
Acute monoarticular arthritis
- night pain
- big toe (usually)
Hyperuricemia responds to?
NSAIDS
Colchicine
Clinical stages of gout?
Stage I: asymptomatic
Stage II: gouty arthritis
Intercriical gout: after attack
Stage III: chronic tophaceous gout
Definitive diagnosis of gout?
Uric acid crystals in joint fluid
Polarized microscopy show NEGATIVELY bifringent and needle-like Na urate crystals
Uric acid level goal (therapy)
= 6
What is the most important aspect of gout tx?
How rapidly tx is initiated
W/in min of flare it may halt progression
Gout tx meds?
- NSAIDS (indomethacin)
- Colchicine
- Glucocorticoids (3rd line)
Continue tx 48-72hrs after to reduce risk of relapse
How is indomethacin given?
Start at max dose
Who gets glucocorticoids (gout)
Reserved for pts who have contraindications to nSAIDS/Colchicine
or
NSAIDS/colchicine are ineffective
During an acute gout attack?
Do not start chronic urate lowering drugs during a gout attack
Intercrtical treatment of gout?
ULT or cholchicine propolaysis
ULT?
Urate lowering drugs (therapy maybe)
Xanthine oxidase inhibitors
- allopurinol/febuxostat
Uricosuric (2nd line)
- probenecid»_space; nephrolitiasis
Indications for ULT?
Tophi
2+ attacks/yr
CKD stage 2+
Urolithiasis
Pseudogout is aka?
Calcium pyrophosphate dihydrate deposition disease
Who gets pseudogout?
MC >60y/o
What causes pseudogout?
Calcium salt deposits in cartilage (chondrocalcinosis) that precipitate in a joint and cause painful arthritis
S/s of pseudogout?
Acute monarticular/oligoarticular arthritis lasting days - 2 weeks
Always suspect pseudogout in:
Elderly hospitalized pt with NEW ACUTE MONOARTHRITIS
Types of pseudogout?
Primary
- idiopathic (aging)
- hereditary
Secondary
- hyperparathyroidism
- hemochromatosis
- hypothyroidism
- hypo Mg2_ and PO4-
Lab findings for pseudogout?
Normal serum uric acid
Joint aspirate: ca pyrophosphate crystals w POSITIVE bifringence on polarized microscopy
Gout vs pseudogout aspirate?
Gout:
- negatively bifringent
- needle like Na urate crystals
Pseudogout:
- positive bifringence
- Ca pyrophosphate crystals
Radiographs for pseudogout?
Calcifications-chondrocalcinosis in knees
Signs of degenerative changes (OA)
Tx for pseudogout?
NSAIDS/COX2 (1st line)
(Same as gout)
Corticosteroids (low dose w taper)
Colchicine (2nd line)
Resistant cases - methotrexate
