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MSK AM > Rheumatic diseases > Flashcards

Rheumatic diseases Flashcards

1
Q

What are crystal deposition diseases?

A

Diseases characterised by deposition of mineralised material within joints and oeri-articular tissue

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2
Q

What are the common crystal deposition diseases?

A

Gout
Pseudogout
Calcific periarthritis/ tendonitis

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3
Q

What is deposited in gout?

A

Monosodium urate

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4
Q

What is deposited in pseudo gout?

A

Calcium pyrophosphate dehydrate

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5
Q

Whatis deposited in calcific periarthritis/ tendonits?

A

Basic calcium phosphate hydroxyl-apatite

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6
Q

What is the pathology of gout?

A

Hyperuricaemia

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7
Q

How is urate formed in the body?

A

Purine from DNA and RNA, and diet broken down to urate and 70% excreted by kidneys

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8
Q

Who is gout seen in?

A

Men > women

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9
Q

What are the 2 classes of causes of gout?

A

Overproduction

Under excretion

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10
Q

What are the overproduction causes of gout?

A 
Malignancy
Severe exfoliative psoriasis
Drugs
Inborn errors of metabolism
HGPRT deficiency
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11
Q

What are the under excretion causes of gout?

A 
Renal impairment
Hypertension
Hypothyrois
Drugs
Exercise
Starvation or dehydration
Lead poisoning
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12
Q

What are the classic features of gout?

A

Flare up starting overnight and lasting 7-10 days

Acute pain and inflammation in 1st MTP joint with peeling of overlying skin

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13
Q

What is Lesch Nyan syndrome?

A

Genetic X linked HGPRT deficiency

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14
Q

What are the clinical features of Lesch Nyan syndrome?`

A 
Intellectual disability
Gout
Renal disease
aggressive and impulsive behaviour
Self mutilation
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15
Q

What investigations are done for gout?

A

Aspirate joint- gram stain to rule put infection, polarising microscopy to confirm gout
Blood uric acid in chronic

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16
Q

What is the management of acute gout?

A

NSAIDs
Colchicine
Steroids

17
Q

When is hyperuricaemia treated in gout?

A 
2nd attack in 1 year
Prophylaxis is certain malignancies
Symptomatic
REnal insufficiency
Urate calculi
Tophaceous or polyarticular gout
18
Q

What are the rules for treating hyperuricaemia in gout?

A

Wait until the end of acute attack

Use small doses and adjust according to rate levels and kidney function

19
Q

What medications are used in the treatment of hyperuricaemia?

A

Xanthine oxidase inhibitor- 1st line
Febuxostat
Uricosuric agents
Canakinumab

20
Q

What risk factors should be addressed in gout?

A 
Overweight
Hypertension
Hypercholesterolaemia
Dehydration
Diuretics
21
Q

Who is pseudo gout seen in?

A

Elderly females

22
Q

What are the causes of pseudo gout?

A

Idiopathic
Familial
Metabolic

23
Q

What are the triggers of pseudo gout?

A

Trauma

Intercurrent illness

24
Q

What is th classic presentation of pseudo gout?

A

Bouts of joint pain and swelling with fluid build up around affected joint, classically the knee

25
Q

What is the management of pseudo gout?

A

NSAIDs

Steroids

26
Q

What is polymyalgia rheumatica?

A

Inflammatory condition of the elderly, classically females

27
Q

What is polymyalgia rheumatica associated with?

A

Giant cell arteritis

28
Q

What are the clinical features of polymyalgia rheumatica?

A

Sudden onset shoulder +/- pelvic girdle stiffnesss
Anaemis
Malaise, weight loss, fever, depression
Arthralgia

29
Q

What is the differential for polymyalgia rheumatica?

A 
Myalgic onset inflammatory jont disease
Underlying malignancy
Inflammatory muscle disease
Hyo/hyperthyroid
Bilateral shoulder capsulitis
Fibromyalgia
30
Q

What are the diagnostic criteria for polymyalgia rheumatica?

A

Compatible history
>50
ESR > 50
Dramatic steroid response

31
Q

What os the treatment of polymyalgia rheumatica?

A

18-24 months 15mg prednisolone

MSK AM (37 decks)

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