MSK fibromyalgia, crystal arthro Flashcards by Becca Stirling

what is fibromyalgia

a neurosensory disorder characterised by chronic musculocutaneous pain
WIDESPREAD body PAIN over 3 months

Pain without any inflam
(FUNCTIONAL DISORDER w/o organic cause - clam & IBS)

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Prevalence and epidemiology of fibromyalgia

4% 10F=M
Female, middle aged, divorced, low household income
RA (12% also have fibromyalgia)

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cause of fibromyalgia

no spec pathology

central disturbances in pain processing

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DDx of fibromyalgia

RA, SLE, hypothyroidism

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what is assos with fibromyalgia

chronic headache
IBS
chronic fatigue
poor sleep
depression

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Rf of fibromyalgia

Female, 
middle aged, 
divorced, 
low household income
RA (12% also have fibromyalgia)

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symptoms of fibromyalgia

wise spread pain, fatigue, sensitivity to pain
“fibro fog” - poor sleep (insomnia), memory, concentration
assos morning stiffness less than 1hr
pain worse in with cold or stress

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signs of fibromyalgia

signs of tenderness (11/18 tender point sites on digital palpitation)
no signs of inflammation

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Dx of fibromyalgia

by exclusion (all tests return negative
exclude RA Myeloma Infection PMR)
pain at 11/18 tender point sites on digital palpatition
(base of skull, upper outer gluteal quadrant, neck n shoulder, hip bone)

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Managment of Fibromyalgis

HOLLISTIC couciling CBT, cardio exercise
amitriptyline - help sleep, anti depressants
pregabalin, gabapentin - anticonvulsants, anxiety

(Analgeisa and analgesic ladder, Tramadol
SSRI dont work too well )

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what is gout

inflam arthritis assos w hyperuricaemia and intraarticular monosodium urate crystals
deposits into tissues (esp 1st metatarsal joint)

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what are the 2 types of Crystal arthropathy and their composition

Gout: uric acid (monosodium urate crystals)
Pseudogout: Calcium pyrophosphate

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Causes of gout (principles)

increased intake of uric acid

decreased excretion of uric acid

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causes of gout

(INTAKE)
increased purine consumption - beer, shellfish, fructose
increased cell turnover - chemo, leukaemia, psoriasis

(EXCRETION)
chronic kidney disease
drugs - thiazide diuretics
dehyrdation - alcohol

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why does increased purine consumption cause gout

gets converted to uric acid when dna brocken down - excreted into urine or urate ion binds with Na+ – monosodium urate crystals (=GOUT)

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what is chronic polyarticular gout

due to long term diueretic use in renal failure

what is trophaceous gout

persistently high uric acid levels - trophi forms from monosodium urate = crystal aggregates and inflam cells

Cfs of gout (acute)

inflam signs - Red/swollen/painful/hot/ loss of function –
monoarthropathy
fever
usually MTP of big toe

Investigation of gout

POLARISED LIGHT MICROSCOPY - NEG bi refingent need shaped crystals
high serum urate - may be noramal is post episode
aspirate joint - excl septic arthritis

RFs of gout

obesity, diabetes, fam hx, hypertension

what is a tophus

chalky subcutaenous nodule (chronic trophaceous gout)

gout pseudo gout mono or poly articulaar

gout =monoarticular

pseudo = Poly articular (PP)

what joint affected in gouts vs pseudo gout

gout = 1st MTPJ

pseudo - knee (larger joints)

cystal in gout v pseudo and polarised light microscopy result

gout = monosodium urate (NEG BIFRINGENCE)
pseudo = calcium pyrophosphate (POS BIFRINGENCE)

polarised light microcopy gout vs pseudo gout

``` gout = neg needle shaped (NN) pseudo = pos rhomboidal ```

Mx off gout

``` lifestyle - weight, alcohol, avoid purine foods (dairy = protective) high dose NSAIDs - naproxen, ibruprofen OR COX INHIB - aspirin COLCHICINE (targets crystallisation) - SE = abdo pain diarrhoea or CORTICOSTEROIDS (prednisolone) PREVENTION - ALLOPURINOL (tx for tumour lysis also) not within 1 month of attack ```

prevention of gout

allopurinol (post 1 month of attack) | =xanthineoxidase inhib

what is protective of gout

dairy foods

what is pseudo gout

calcium pyrophosphate crystals deposited on joint surface - shed into joint= acute synovitis (resmebles acute gout)

X ray changes on chronic gout

Punched out cortex

CFs of pseudo gout

poly articular knee/wrist hot joint fever (similar to gout presentation)

DDx

septic arthritsi | exl w aspiration and culture

Dx of pseudo gout

polarised light microscopy - POS birefringence - small rhomboidal crystals Purulent joint fluid - culture to excl septic arthritis Xray - chonedrocalceriosis bloods - high WCC

Rfs of pseudogout

``` elderly woman joint injury or trauma HYPERPARATHYROIDISM osteoarthritis HAEMOCHROMATOSIS ```

assos of psuedo gout

haemochromatosis hyperparathyroidim osteoarthritis

features of chronic gout

excess uric acid deposition throughout forming tophi

Prevalence of gout n epidem

commonest cause of arthritis in men <40 YO | 1%

Tx of pseudogout

symptomatic Cool, rest NSAID if CI give colchicine (like in gout) steroid injections

which is milder gout or pseudo

pseudo