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Year 2- MSK > Crystal Arthropathies and Polymyalgia Rheumatica (PMR) > Flashcards

Crystal Arthropathies and Polymyalgia Rheumatica (PMR) Flashcards

1
Q

What are crystal deposition diseases characterised by?

A

Deposition of mineralised material within joints and peri-articular tissue

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2
Q

Which crystal deposition diseases are commonly seen in practice?

A

Gout
Pseudogout
Calcific periarthritis/tendonitis

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3
Q

Which crystal is deposited in gout?

A

Monosodium urate

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4
Q

Which crystal is deposited in pseudogout?

A

Calcium pyrophosphate dihydrate (CPPD)

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5
Q

Which crystal is deposited in calcific periarthirits/tendonitis?

A

Basic calcium phosphate hydoxy-apatite (BCP)

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6
Q

In gout, what is there excess of in the blood?

A

High levels or purines/uric acid

->uric acid is the end product of metabolised purines

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7
Q

How does the body get purines?

A

Through the diet

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8
Q

Hyperuricaemia?

A

Overproduction of uric acid in the blood

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9
Q

In which conditions is hyperuricaemia commonly seen?

A

Lymph proliferative malignancies
Tumour lysis syndrome
Severe exfoliative psoriasis
Renal impairment

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10
Q

Which drugs can cause hyperuricaemia?

A

Ethanol (alcohol)
Cytotoxic drugs

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11
Q

Where are purines excreted from?

A

Approx 75% from kidneys
25% from GIT

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12
Q

What is a major source of purines?

A

Alcohol

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13
Q

Lesch Nyan Syndrome?

A

HGPRT deficiency (type of enzyme) so uric acid overproduction
Intellectual disability with aggressive and impulsive behaviour

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14
Q

What kind of inherited condition is Lesch Nyan syndrome?

A

X-linked recessive

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15
Q

Which other health issues can occur with Lesch Nyan syndrome?

A

Self mutilation (self harm)
Gout
Renal disease

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16
Q

Who more commonly gets gout?

A

Older men

->think of GP case I saw cos that was an old man
also note, very rare in premenopausal women so if see this in diagnosis, look again and make sure

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17
Q

Is there a link to family history in gout?

A

Yes, v strong FH association

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18
Q

Signs of gout?

A

Red and swollen joint

->look for scalp psoriasis as well, as previously mentioned, can be caused by psoriasis

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19
Q

Risk factors for gout?

A

Hypertension
Diabetes
Hyperlipidaemia
Family history

->often lifestyle driven by a lifestyle of excess e.g. excess eating and drinking but can be caused by medications too

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20
Q

Some of the differential diagnosis or gout?

A

Any inflammatory joint condition
Infection- e.g. if swollen knee, aspirate to rule out infection

21
Q

What is the gold-standard investigation for gout?

A

Fluid sample from joint to look under microscope

22
Q

Would you test urate in bloods in someone with suspected gout?

A

Can be difficult as if acute attack of gout, urate levels will be low

->if cannot identify gout from a joint aspirate, check urate blood levels again in a few weeks

23
Q

What are x-rays good for regarding joints?

A

To see if there is any damage to joint but not useful in an acute attack

24
Q

Basically- are x-rays and US good for gout?

A

Not really as would need to be really advanced before seeing anything so by that point, will have been missed

25
Q

Which joint does gout classically start?

A

First MCP joint

26
Q

Does gout start suddenly or build up?

A

Starts very suddenly

27
Q

Tophi build up in gout. What are they?

A

Deposit of the monsodium urate crystals

->very painful

28
Q

Tophus tophi?

A

Massive accumulations of uric acid

->check pinna of ear as can accumulate here too

29
Q

How many joints tend to be affected by gout?

A

Typically one but can occur in more than one

30
Q

Gold standard management of gout?

A

Aspirate the joint and then inject steroids

31
Q

What is used in the management of an acute flair of gout?

A

NSAIDs
Colchicine
Steroids

32
Q

Sometimes gout doesn’t need to be treated. The first attack of gout is only treated if….

A
  1. Single attack of polyarticular gout
  2. Tophaceous gout
  3. Urate calculi
  4. Renal insufficiency
33
Q

Who cannot have anti-inflammatory durgs?

A

Patients with renal insufficiency

34
Q

What is the first line of treatment for lowering uric acid?

A

Xanthine oxidase inhibitors e.g. Allopurinol

->can be used in renal impairment too
If not tolerated, Febuxostat is next line of action

35
Q

What are the rules to follow when lowering uric acid levels?

A
  1. Wait until acute attack has stopped
  2. Use prophylactic NSAIDs or low dose steroids until uric acid levels are normal
  3. Adjust allopurinol dose according to renal function
36
Q

What lifestyle factors help in gout management?

A

Smoking cessation
Lower consumption of highly processed foods
Reduce alcohol consumption
Increase water intake

->lots of people get a flare up of gout when on holidays because they don’t drink enough water and too much alcohol

37
Q

Gout usually affects toes.
Where does pseudogout usually affect?

A

Knee, can affect wrist but mostly knee

38
Q

Who is more likely to develop pseudogout?

A

Elderly females

39
Q

What are some of the causes of pseudogout?

A

Idiopathic
Familial
Metabolic

40
Q

What are some of the triggers of pseudogout?

A

Trauma
Intercurrent illness

41
Q

What is important to note about sending off urate crystals to the labs?

A

They disintegrate very quickly so need to be sent off immediately

42
Q

Management of pseudogout?

A

NSAIDs
Intra-articular steroids

43
Q

Polymyalgia Rheumatica is very difficult to diagnose as very similar to many other conditions.
Which condition in particular if you suspected Polymyalgia Rheumatica would you also have to screen for?

A

Giant Cell Arteritis

->very important not to miss as risks of stokes and blindness associated with GCA,

44
Q

What is the most important part of a presentation which are indicative of polymalgai rheumatica?

A

SUDDEN onset of shoulder +/- pelvic girdle STIFFNESS

45
Q

What age do people tend to get polymyalgia rheumatica?

A

> 70

->rare <50 so be suspicous of underlying condition e.g. malignancy

46
Q

What are some of the features/symptoms of polymyalgia rheumatica?

A

ESR usually >45, often even 100
Anaemia
Malaise
Weight loss
Fever
Depression

47
Q

How is a diagnosis of polymyalgia rheumatica made?

A

No blood test or test for definite diagnosis
Based on history, age >50, ESR >50
Will have a dramatic steroid response

->looks like many other conditions, DD = inflam joint disease, underlying malignancy, inflam muscle disease, hypo/hyperthyroidism

48
Q

Treatment for polymyalgia rheumatica?

A

Prednisolone
Bone prophylaxis

->bone proph is because course of steroids is for 18-24 months and anyone on steroids for >5 months need bone protection

49
Q
A

Year 2- MSK (36 decks)

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