Crystalline arthropathies Flashcards
What is the most common type of inflammatory arthritis
Gout
Which gender does gout effect more
male
Patient comes in with a red, swollen, painful firth MTP joint. What is this presentation called?
Podagra
Which molecules are metabolized into uric acid for gout
Nucleic acid
What does a build up of uric acid precipitate
Crystal formation in the joints and soft tissue
What are the two main forms of gout
Acute
Chronic
If there is rapid onset joint pain, swelling that occurred but clears up in 3-10 days. What is the likely diagnosis
Acute gout
If there is deposition of MSU in tissues following acute gout attacks, what is the most likely diagnosis
Chronic gout
If a patient presents with acute onset of monoarticular joint pain with erythema and edema. Pain that is out of proportion to exam, and has decreased range of motion. What is the most likely diagnosis
Acute gout attack
What is tophaceous gout
Chronic joint deformity with edema. No erythema or pain. With chalky white deposits
What is the gold standard to identify crystals in the synovial fluid
Arthrocentesis
What type of imaging evidence is supportive to a gout diagnosis
Punched out lesions (Rat bite)
Overhanging sclerotic borders
Soft tissue tophi
What are the best drug options for an acute gout attack
Indomethacin (NSAID- first line)
Colchicine
Steroids
When is colchicine used in an acute gout attack
When there is renal disease, GI disease, or elderly
When are steroids used in acute gout and what forms are used
When unable to take NSAIDS
Can take oral if polyarticular
Intra-articular injection is monoarticular
When are prevention drugs for gout introduced in treatment
When a person has had > 2 attacks in a year
High uric acid levels
Tophi present
Failure of symptomatic treatment
What is the first line drug for in chronic gout prevention
Allopurinol
What needs to be given along side allopurinol when initially starting treatment
Co-adminiter with either indomethacin or colchicine to prevent an acute attack
What are the options for treatment of chronic gout
Allopurinol
Colchicine
Febuxostat
Probenicid
PEGylated
Which gender is more likely to have pseudogout
Females
Where does pseudo gout generally occur
Large joints
What is the difference in crystals between regular gout and pseudo gout
Regular= spear
Pseudogout= Rhomboid
Who is at high risk for pseudogout
Herparathyroidism
Hemochromatosis
Hypomagnesemia
Hypophosphatemia
Certain autoimmune disorders (SLE/RA)
There is a patient that presents with acute onset of monoarticular joint pain and tenderness in the knees and wrists. What is the likely diagnosis
Pseudogout
What is the gold standard for diagnosing pseudogout
CPP crystals in the synovial fluid
