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MSK > Crystal Atrophy > Flashcards

Crystal Atrophy Flashcards

1
Q

How are crystal deposition diseases characterised

A

Deposition of mineralised material with joints and peri-articular tissue

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2
Q

3 common crystal deposition diseases

A
  • Gout (Monosodium urate)
  • Pseudogout (Calcium pyrophosphate dihydrate)
  • Calcific periarthritis/tendonitis (Basic calcium phosphate hydroxyl apatite)
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3
Q

How are purines metabolised

A

Purines => Hypoxanthine => Xanthine => Plasma urate => Urine uric acid => excretion

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4
Q

How do purines become hypoxanthine

A

HGPRT

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5
Q

2 basic reasons for hyperuricaemia

A
  • Overproduction

- Under excretion

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6
Q

5 over production causes of hyperuricaemia

A
  • Malignancy (lymphoproliferative, tumour lysis syndrome)
  • Severe exfoliative psoriasis
  • Drugs (ethanol, cytotoxic drugs)
  • HGRPT deficiency
  • Inborn errors of metabolism
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7
Q

5 under excretion causes of hyperuricaemia

A
  • Renal impairment
  • Hypertension
  • Drugs (alcohol, low dose aspirin, diuretics, cyclosporin)
  • Exercise, starvation, dehydration
  • Lead poisoning
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8
Q

Describe Lesch Nyan Syndrome

A
  • HGPRT deficiency
  • X-linked recessive
  • Intellectual disability
  • Aggressive + impulsive behaviour
  • Self mutilation
  • Renal disease
  • Gout
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9
Q

Is gout more prevalent in men or women

A

Men, by some margin (in UK)

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10
Q

Rx of an acute flare up of gout

A
  • NSAIDs
  • Colchicine
  • Steroids (IA/IM/Oral)
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11
Q

When to treat hyperuricaemia

A

Only treat 1st attack if:

  • Single attack of polyarticular gout
  • Tophaceous gout
  • Urate calculi
  • Renal deficiency
  • Treat if 2nd attack within 1 yr
  • Prophylactically prior to certain malignancies

DO NOT TREAT ASYMPTOMATIC HYPERURICAEMIA

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12
Q

Rx to lower uric acid

A
  • Xanthine oxidase inhibitor (Allopurinol, Febuxostat)
  • Uricosuric agents (Sulphinpyrazone, Probenecid)
  • Canakinumab (monoclonal antibody targeted at interleukin-1 beta)
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13
Q

3 rules of lowering uric acid levels

A
  • Wait until the acute attack has settled before attempting to reduced the urate level
  • Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
  • Adjust allopurinol dose according to renal function
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14
Q

Describe Pseudogout

A
  • Elderly females (mainly)
  • Erratic flares
  • Idiopathic, familial, metabolic
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15
Q

Triggers of Pseudogout

A
  • Trauma

- Intercurrent illness

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16
Q

Management of Pseudogout

A

-NSAIDs
-IA steroids
There are no prophylactic therapies

17
Q

How are polymyalgia rheumatica, giant cell arteritis and High ESR + anaemia related

A
  • 20% of patients with PMR have evidence of GCA
  • 50% of patients with GCA may have PMR

PMR => GCA => HIGH ESR => PMR => GCA => HIGH ESR

18
Q

Presentation of polymyalgia rheumatica

A
  • SUDDEN onset of shoulder +/- pelvic girdle STIFFNESS
  • Rare in <50 yr usually >70yr
  • F:M = 2:1
  • Anaemia
  • ESR usually >45 often 100
  • Malaise, weight loss, fever, depression
  • Arthralgia/synovitis occasionally
19
Q

How to diagnose polymyalgia rheumatica

A
  • Compatible Hx (age >50)
  • ESR > 50
  • Dramatic steroid response
  • No specific diagnostic test
20
Q

DDx for polymyalgia rheumatica

A
  • Underlying malignancy (multiple myeloma, lung cancer)
  • Hypo/hyperthyroidism
  • Bilateral shoulder capsulitis
  • Fibromyalgia
  • Myalgic onset inflammatory joint disease
21
Q

Rx of polymyalgia rheumatica

A
  • Prednisolone (15mg/day initially)
  • 18-24 month course
  • Bone prophylaxis

MSK (28 decks)

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