Rheumatic diseases Flashcards
What are crystal deposition diseases?
Diseases characterised by deposition of mineralised material within joints and oeri-articular tissue
What are the common crystal deposition diseases?
Gout
Pseudogout
Calcific periarthritis/ tendonitis
What is deposited in gout?
Monosodium urate
What is deposited in pseudo gout?
Calcium pyrophosphate dehydrate
Whatis deposited in calcific periarthritis/ tendonits?
Basic calcium phosphate hydroxyl-apatite
What is the pathology of gout?
Hyperuricaemia
How is urate formed in the body?
Purine from DNA and RNA, and diet broken down to urate and 70% excreted by kidneys
Who is gout seen in?
Men > women
What are the 2 classes of causes of gout?
Overproduction
Under excretion
What are the overproduction causes of gout?
Malignancy Severe exfoliative psoriasis Drugs Inborn errors of metabolism HGPRT deficiency
What are the under excretion causes of gout?
Renal impairment Hypertension Hypothyrois Drugs Exercise Starvation or dehydration Lead poisoning
What are the classic features of gout?
Flare up starting overnight and lasting 7-10 days
Acute pain and inflammation in 1st MTP joint with peeling of overlying skin
What is Lesch Nyan syndrome?
Genetic X linked HGPRT deficiency
What are the clinical features of Lesch Nyan syndrome?`
Intellectual disability Gout Renal disease aggressive and impulsive behaviour Self mutilation
What investigations are done for gout?
Aspirate joint- gram stain to rule put infection, polarising microscopy to confirm gout
Blood uric acid in chronic
What is the management of acute gout?
NSAIDs
Colchicine
Steroids
When is hyperuricaemia treated in gout?
2nd attack in 1 year Prophylaxis is certain malignancies Symptomatic REnal insufficiency Urate calculi Tophaceous or polyarticular gout
What are the rules for treating hyperuricaemia in gout?
Wait until the end of acute attack
Use small doses and adjust according to rate levels and kidney function
What medications are used in the treatment of hyperuricaemia?
Xanthine oxidase inhibitor- 1st line
Febuxostat
Uricosuric agents
Canakinumab
What risk factors should be addressed in gout?
Overweight Hypertension Hypercholesterolaemia Dehydration Diuretics
Who is pseudo gout seen in?
Elderly females
What are the causes of pseudo gout?
Idiopathic
Familial
Metabolic
What are the triggers of pseudo gout?
Trauma
Intercurrent illness
What is th classic presentation of pseudo gout?
Bouts of joint pain and swelling with fluid build up around affected joint, classically the knee
