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MSS 2 > Crystal-Induced Arthritis > Flashcards

Crystal-Induced Arthritis Flashcards

1
Q

What are the characteristic features of crystal-induced arthritis?

A
  • acutely painful
  • monoarticular (one joint)
  • remits spontaneously (intermittent)
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2
Q

*** What crystal is associated with gout?

A
  • monosodium urate monohydrate
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3
Q

*** What crystal is associated with pseudogout?

A
  • calcium pyrophosphate dihydrate
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4
Q

What is gout?

A
  • metabolic disease characterized by hyperuricemia, which manifests by acute arthritis (tophi) or renal stones.
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5
Q

Is gout a men’s or lady’s disease?

A
  • mens
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6
Q

What is at the center of purine metabolism?

A
  • inosinic acid
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7
Q

What medication blocks xanthine oxidase?

A
  • allopurinol= prevents production of uric acid.
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8
Q

Why has prevalence of gout doubled in the last 15 years?

A
  • longevity (increase in DM and CHF)
  • use of ASA and thiazide diuretics
  • HTN
  • increase in caloric intake
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9
Q

How do we classify gout?

A
  • primary (idiopathic) or specific enzyme abnormalities: G6Phosphatase, HGPRTase, or PRPP synthetase
  • secondary (nucleic acid turnover
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10
Q

What is Lesch-Nyhan syndrome?

A
  • total deficiency of HGPRTase
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11
Q

What clinical disorders lead to purine overproduction?

A
  • myeloproliferative diseases
  • lymphoproliferative diseases
  • polycythemia vera
  • malignancies
  • hemolysis
  • psoriasis
  • obesity
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12
Q

What is a normal uric acid level?

A
  • 6
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13
Q

What drugs can decrease clearance of uric acid?

A
  • thiazide diuretics
  • ethanol
  • salicylates
  • ethambutal
  • pyrazinamide
  • levadopa
  • laxatives
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14
Q

Why does gout like the big toe?

A
  • coldest joint in the body (uric acid accumulates at lower temperatures)
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15
Q

What is a tophus?

A
  • collection of urate in the soft tissue.
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16
Q

How can you differentiate a gout tophus from an RA nodule?

A
  • stick a needle in it, and look for crystal of uric acid.
17
Q

What are the clinical manifestations of gout?

A
  • acute intermittent arthritis (podagra= pain in big toe)
  • chronic gouty arthritis (tophaceous)
  • renal presentation (uric acid lithiasis; radiolucent).
  • gouthy nephropathy, HTN/proteinuria).
  • asymptomatic hyperuricemia
18
Q

Are uric acid crystals strongly negatively birefringent?

A
  • YES

* remember GYB (gout goes yellow to blue).

19
Q

What radiologic finding is pathognomonic for gout?

A
  • overhanging edge sign
20
Q

How do you diagnose gout?

A
  • arthrocentesis (synovial fluid crystals)
  • uric acid calculi
  • tophaceous deposits
21
Q

Which drug would you use to make a presumptive diagnosis of gout?

A
  • COLCHICINE!!!
22
Q

Why don’t we use colchicine to treat gout anymore?

A
  • bc 80% of pts will get diarrhea and dysentery
23
Q
  • How do we treat acute arthritis due to gout?
A
  • NSAIDs (don’t use aspirin, bc it will raise uric acid).

- short course of steroids

24
Q

How do we treat chronic gout?

A
  • uricosuric drugs

- allopurinol

25
Q

*** What is the best drug to prevent break-through attacks of gout?

A
  • just a little bit of colchicine
26
Q

Do we treat aysmptomatic hyperuricemia?

A
  • NO
27
Q

May allopurinol be cardioprotective?

A
  • YES
28
Q

What is Febuxostat?

A
  • New drug for gout but expensive.
29
Q

What is Pegloticase?

A
  • IV drug for severe refractory gout
30
Q

What is lesinurad?

A
  • new uricosuric agent used in combination with xanthine oxidase inhibitor.
31
Q

** What do you call calcification within the fibrocartilage of the meniscus?

A
  • CHONDROCALCINOSIS (made of calcium pyrophosphate).

* PSEUDOGOUT

32
Q

*** What is the most common joint involved in the pseudogout?

A
  • the knee followed by the wrist
33
Q

What type of birefringence will you see in pseudogout?

A
  • weakly positively birefringent crystals
34
Q

What are the top 3 associated conditions with pseudogout (CPPD)?

A
  • gout
  • hemochromatosis (get an iron level)
  • hyperparathyroidism (do a PTH)
  • hypothyroidism (do a TSH)

MSS 2 (15 decks)

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