Gout And Other Crystal-associated Arthropathies Flashcards
Polarized light microscopy can identify most typical crystals except
Apatite
Most common early clinical manifestation of gout
Acute arthritis
Most commonly involved joint in gout
1st MTP joint
Rare type of gout unless with strong family history
Premenopausal gout
Indications for 24-hour urine collection for uric acid
Risk for stones
Determining if overproducing or underexcreting uric acid
Deciding appropriateness of uricosuric therapy
Purine overproduction
Urinary excretion of > 800mg uric acid per 24hours
Mainstay of treatment for acute gout
Anti-inflammatory drugs (colchicine, NSAIDs, glucocorticoids)
What to do when with loose stools while taking colchicine
Stop colchicine at once
Goal uric acid for gout
5-6 mg/dl
Most commonly used hypouricemic agent for gout
Allopurinol - best for overproducers, with urate stones, with renal disease
Most serious side effect of allopurinol
Rash that can progress to TEN Systemic vasculitis Bone marrow suppression Granulomatous hepatitis Renal failure
Duration of colchicine prophylaxis and hypouricemic agent
Until normouricemic and with no gouty attacks for 6 months or until with tophi
5 conditions associated with CPPD arthritis (5H)
Hyperparathyroidism Hemochromatosis Hypomagnesemia Hypophosphatasia Hereditary
Most frequently involved joint in CPPD disease
Knee
Presumptive diagnosis of CPPD
Chondrocalcinosis
Most common precipitant of CPPD disease
Trauma
Appearance of MSU crystals in polarized light microscopy
Needle shaped, negative birefringence
Appearance of CPPD crystals in polarized light microscopy
Rhomboid/square/rod-like, weak positive birefringence
Appearance of calcium apatite crystals in polarized light microscopy
Not seen - crystals are very small and can only be seen via electron microscopy (nonbirefringent globules, stain red with alizarin red S and purple with Wright’s stain)
Appearance of calcium oxalate crystals in polarized light microscopy
Bipyramidal, strong birefringence, stain with alizarin red S
Most common sites of calcium apatite deposition
Bursae and tendons in and/or around knees, shoulders, hips, fingers
Most common conditions associated with calcium apatite deposition
Hyperparathyroidism and hyperphosphatemia in renal failure/ESRD patients
Most common condition associated with calcium oxalate deposition
ESRD patients on HD being given ascorbic acid
