Gout and other Crystal-associated Arthropathies

Question 1

Gout deposits

Answer 1

MSU crystals
(needle and rod-shaped, brightly birefringent with negative elongation)

Question 2

MC early clinical manifestation of gout

Answer 2

Acute arthritis

Question 3

Most often involved in gout

Answer 3

Metatarsophalangeal joint of the first toe

attacks frequently at night, subside spontaneously within 3-10 days

Question 4

Confirmatory test of gout

Answer 4

Needle aspiration of involved joints

Question 5

Characteristics of gouty effusions

Answer 5

cloudy

thick pasty or chalky fluid

Question 6

Can be useful in assessing the risk of stones

Answer 6

24H urine collection

Question 7

Overproduction of uric acid

Answer 7

excretion of >800mg of uric acid per 24h on a regular diet

Question 8

Radiologic findings of gout

Answer 8

cystic changes + well-defined erosions with sclerotic margins + soft tissue masses

on utz: Double contour sign

Question 9

Given in early gout attack

Answer 9

Colchicine 0.6mg 1 tab q8 and taper or 1.2mg followed by 0.6mg in 1h

Question 10

Side effect of Colchicine

Answer 10

Diarrhea (d/c immediately)

Question 11

Effective in polyarticular gout

Answer 11

Glucocorticoids

Question 12

IL 1B effective in acute gout

Answer 12

Anakinra

Question 13

Goal of hypouricemic therapy

Answer 13

Normalize uric acid to <300-360 umol/L (5-6 mg/dL)

to prevent recurrence and eliminate tophi

(<6 mg/dL in phil cpg)

Question 14

Hypouricemic therapy which can be used in patients with good renal function who UNDEREXCRETE uric acid
(<600mg in a 24h urine sample)

Answer 14

Probenacid

not effective for crea >2mg/dL

Question 15

Best xanthine oxidase inhibitor to lower urate in OVERproducers of urate, urate stone formers and patients with renal disease

Answer 15

Allopurinol

Question 16

MC age group affected by CPPD

Answer 16

Elderly (30-50% >85 years old)

Question 17

Pathogenesis of CPPD

Answer 17

Increased production of INorganic pyrophosphate and decreased levels pyrophosphatase in cartilage extracts

Question 18

Diseases associated with CPPD esp in <50 years old

Answer 18

Hypeparathyroidism
Hemochromatosis
Hypophosphatemia
Hypomagnesemia
Gitelman’s

Question 19

Most frequently affected in CPPD arthropathy

Answer 19

Knee joint

Question 20

Radiologic finding in CPPD

Answer 20

Chondrocalcinosis or punctate and/or linear radiodense deposits

(may be present in CaOx)

Question 21

Definitive diagnosis of CPPD

Answer 21

Typical rhomboid or rodlike crystals, weakly positive birefringent in synovial fluid

Question 22

Gene mutation associated with CPPD

Answer 22

ANKH

Question 23

Most frequently affected in Calcium Apatite Deposition Disease

Answer 23

Shoulders (Milwaukee shoulders)

Frequently deposit in bursae and tendons

Question 24

Radiographic findings of calcium apatite

Answer 24

Intra and/or periarticular calcifications with or without erosive, destructive or hypertrophic changes

Question 25

EM findings of Apatite

Answer 25

clumps of crystals shiny nonbirefringent globules or aggregates

Question 26

Microscopic findings of CaOx

Answer 26

Bipyramidal or variable, strong birefringence

Question 27

Treatment in primary oxalosis

Answer 27

Liver Transplantation

Question 28

Uric Acid Goal

Answer 28

<7 mg/dL males <6 mg/dL females ( x 60 for umol/L)

Question 29

Increases risk of gout

Answer 29

Meat + seafood + alcohol

Question 30

Risk factors for gout

Answer 30

``` Obesity Hypertension Malignancies Psoriasis CHF ```

Question 31

Hypouricemic therapy indications

Answer 31

After 2 attacks SUA >9mg/dL Willing ti commit to lifelong therapy Uric acid stones With tophi/chronic gout

Question 32

Most serious side effect of Allopurinol

Answer 32

TEN

Question 33

Associated risk factors for Apatite

Answer 33

Hyperphosphatemia CKD Metastatic Calcification