crystallin arthropathies

Question 1

three main crystal types

Answer 1

basic calcium phosphate, calcium pyrophosphate dihydrate, monosodium urate

Question 2

Where does BCP deposit

Answer 2

soft tissue (Acute calcific periarthritis), joints (Bcp arthropathy), tendons (Calcific tendonitis); ABC’s of BCP

Question 3

Milwaukee shoulder syndrome

Answer 3

BCP arthropathy. Destroys rotator cuff, cannot abduct arm.

Question 4

A’s of BCP

Answer 4

acute calcific peritarthritis, alizarin red stain, atypical gout (young women)

Question 5

B’s of BCP

Answer 5

BCP arthropathy, not Birefringent, beer (milwaukee shoulder)

Question 6

C’s of BCP arthropathy

Answer 6

Calcific tendinitis, cuff (supraspinatus), coins (shiny coins on LM)

Question 7

CPPD crystals deposit where? Most common presentation?

Answer 7

cartilage, joint space (pseudogout). Most common sites are meniscus and ulnar styloid. Usually asymptomatic

Question 8

pseudogout: when do you see it? diagnosis?

Answer 8

in CPPD. Aspirate shows inflammation and crystals w/ PMNs

Question 9

Treatment for BCP and CPPD

Answer 9

anti-inflammatories. No prevention, just treatment of attacks

Question 10

How does hyperuricemia relate to gout. How do they get that way? Differentiate

Answer 10

necessary but not sufficient. Underexcretor (1000mg/24hrs).

Question 11

four stage of gout

Answer 11

asymptomatic hyperuricemia (only 15% progress to gout), acute gouty arthritis, intercritical gout, chronic tophaceous gout

Question 12

Treatment of gout

Answer 12

xanthine oxidase inhibitors(lesss urate production), uricosurics (more in urine), uricases (lowers serum urate)

Question 13

xanthine oxidase inhibitors

Answer 13

allopurinol (most common tx), Febuxostat

Question 14

uricosurics

Answer 14

probenecid

Question 15

uricases

Answer 15

pegloticase/krystexa

Question 16

when do you initiate allopurinol

Answer 16

2-4 wks after resolution of acute attack

Question 17

when do you consider febuxostat

Answer 17

in patients who can’t take allopurinol or doesnt work or renal insufficiency