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MSK > Commonly encountered rheumatic diseases: crystal arthropathies & polymyalgia rheumatica > Flashcards

Commonly encountered rheumatic diseases: crystal arthropathies & polymyalgia rheumatica Flashcards

1
Q

How are crystal deposition diseases characterised

A

Depositions of mineralised material within joints and peri-articular tissue

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2
Q

What is the most common crystal seen in practice

A

Monosodium urate - gout

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2
Q

What condition is monosodium urate linked to

A

gout

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3
Q

What condition is CPPD - calcium pyrophosphate dihydrate linked to

A

Pseudogout

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3
Q

What is BCP - basic calcium phosphate hydroxy-apatite linked to

A

Calcific periarthritis / tendonitis

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4
Q

What is hyperuricaemia caused by

A

Overproduction
Malignancy
severe exfoliative psoriasis
Drugs such as ethanol
HGPRT deficiency
Under excretion
Renal impairment
hypertension
hypothyroidism
Alcohol
Aspirin
Starvation, dehydration
Lead poisoning

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5
Q

Does alcohol contain purines

A

Yes it is a major source

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6
Q

What is Lesch Nyan syndrome

A

HGPRT deficiency which causes an error in purine metabolism

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7
Q

What are some complications of Lesch Nyan syndrome

A

Intellectual disability
Aggressive and impulsive behaviour
self mutilation
gout
renal disease

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8
Q

Who is gout more common in

A

Older male

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9
Q

Who is gout not common in

A

Premenopausal women due to oestrogen

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10
Q

What should be asked in gout history

A

How long it has lasted, which joint is affected, family history and lifestyle - smoking alcohol and exercise

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11
Q

What should be checked in examination of gout

A

Will find red hot swollen and swellings at the bursa (usually the olecranon)

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12
Q

What are risk factores for gout

A

High blood pressure, diabetes and hyper lipidaemia

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13
Q

What is checked in investigation of gout

A

pull fluid out of joint and do microscopy
X-rays - checking damage to the joint which occurs late and erosions to the bone
Ultrasound can show chronic deposition of uric acid
Bloods can be done to look for uric acid

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14
Q

What drugs can cause gout

A

Diuretics such as furosemide
Alcohol

15
Q

What are tophi

A

Acute accumulations of uric acid

16
Q

What is the first line, second line and third line treatment of gout

A

first line - anti-inflammatories
Second line - colchicine - anti-inflammatory
3rd line - steroids - if colchicine does not work

17
Q

When should gout be treated

A

If there is a single polyarticular case of gout in one year

If there is more than one attack of gout in a year

If trophaceous gout are present

If ureteric calculi form

18
Q

What is the first line, second line and 3rd line treatment to lower uric acid

A

Xanthine oxidase inhibitors - Allopurinol

Febuxostat second line

Uricocuric is 3rd line - probenecid

19
Q

How do xanthine oxidase inhibitors work

A

Block the conversion of hypoxanthine to xanthine which reduces urine acid production

20
Q

What are the rules when using drugs to lower uric acid levels

A

Wait until the acute attack has settled

21
Q

What is the prophylactic treatment which is used during the acute attack

A

NSAIDs or low dose colchicine - anti-inflammatory or steroids until the urate level is normal

22
Q

What is the correlation and hydration

A

Being more hydrated reduces chance of gout

23
Q

Why is gout more common in holidays

A

The hotter climate making people more dehydrated mixed with more alcohol makes perfect conditions for gout

24
Q

What area is most commonly affected in gout

A

toe

25
Q

What area is most commonly affected by pseudo gout

A

knee

26
Q

Who is pseudo gout more common in

A

Elderly women

27
Q

What is the correlation between pseudo gout and osteoarthritis

A

Osteoarthritis puts at risk of developing pseudo gout

28
Q

How is psuedogout treated

A

NSAIDS first line
Intra-articular steroids second line

29
Q

What is giant cell arteritis commonly associated with

A

Polymyalgia rheumatica

30
Q

What is the main symptom of polymyalgia rheumatica

A

Sudden onset of shoulder with or without pelvic girdle stiffness

31
Q

Which age group is polymyalgia rheumatica rare in

A

under 50 years of age

32
Q

Which gender is polymyalgia rheumatica most common in

A

Females

33
Q

What is the plasma viscosity seen in polymyalgia rheumatica

A

1.86

34
Q

What does polymyalgia rheumatica present with systematically

A

malaise, weight loss, fever and depression

35
Q

How is polymyalgia rheumatica diagnosed

A

No specific diagnostic test
A history that matches normal presentation
Age over 50
Plasma viscosity of 1.86
Dramatic steroid response

36
Q

What is the treatment for polymyalgia rheumatica

A

prednisolone 15mg per day over a 18 month to 24 months course

37
Q
A

MSK (36 decks)

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