6.6. Rheumatology - Crystal Arthropathies Flashcards Preview

3rd Year - MSK Diseases > 6.6. Rheumatology - Crystal Arthropathies > Flashcards

Flashcards in 6.6. Rheumatology - Crystal Arthropathies Deck (36):
1

What characterises Crystal Arthropathies?

Deposition of Mineralised Material within the Joints and Peri-Articular Tissue

2

What are common Crystal Arthropathies?

1. Gout
2. Pseudogout
3. Calcified Periarthritis / Tendonitis

3

What crystal deposition is associated with Gout?

Monosodium Urate

4

What crystal deposition is associated with Pseudigout?

Calcium Pyrophosphate Dihydrate

5

What crystal deposition is associated with Calcified Periarthritis / Tendonitis?

Basic Calcium Phosphate Hydroxy-apatite (BCP)

6

What is a Tophus?

A Massive accumulation of Uric Acid

7

What contributes to the bodies Urate pool?

1. 2/3 - Endogenous production of Uric Acid from degradation or Purines
2. 1/3 - Dietary

8

What happens to the Uric Acid (produced Daily)?

1. 70% - Excreted via the Kidney
2. 30% - Eliminated into the Biliary Tract, and converted into Allantoin (by Bacteria Uricase)

9

What are the 2 methods by which Hyperuricaemia can occur?

1. Overproduction
2. Under-Secretion

10

By what methods does Overproduction cause Hyperuricaemia?

1. Malignancy
2. Severe Exfoliative Psoriasis
3. Drugs
4. Inborn Errors of Metabolism
5. HGPRT Deficiency (Lesch-Nyan Syndrome)

11

What types of Malignancy can cause Hyperuricaemia, via Overproduction?

1. Lymphoproliferative
2. Tumor Lysis Syndrome

12

What types of Drugs can cause Hyperuricaemia, via Overproduction?

1. Ethanol
2. Cytotoxic Drugs

13

By what methods does Under-Secretion cause Hyperuricaemia?

1. Renal Impairment
2. Hypertension
3. Hypothyroidism
4. Drugs
5. Exercise, Starvation, Dehydration
6. Lead Poisoning

14

Why does Hyperuricaemia result in the vast majority of people with Gout?

Reduced Efficiency of Renal Urate Clearance

15

What types of Drugs can cause Hyperuricaemia, via Under-Secretion?

1. Alcohol
2. Low-Dose Aspirin
3. Diuretics
4. Cyclosporin

16

What deficiency is assoiciated with Lesch-Nyan Syndrome?

Deficiency of the enzyme Hypoxanthine-Guanine Phosphoribosyl Transferase (HGPRT)

17

How is HGPRT Deficiency transferred in Lesch-Nyan Syndrome?

X-Linked Recessive

18

What is the function of HGPRT?
Note - related to Lesch-Nyan Syndrome

This plays a key role in the recycling of the Purine Bases (Hypoxanthine and Guanine)

19

What happens in the Absence of HGPRT?
Note - relates to Lesch-Nyan Syndrome

1. The Purine Bases cannot be salvaged, so are degraded / excreted as uric acid
2. Synthetic rate of Purines is accellerated - causing the overproduction of Uric Acid

20

How does Lesch-Nyan Syndrome present?

1. Intellectual Disability
2. Aggressive and Impulsive Behaviour
3. Self-Mutilation
4. Gout
5. Renal Disease

21

Who commonly gets Gout?

Elderly Males
Note - males have higher Urate Levels and increased prevalence at all ages

22

How is Gout Diagnosed?

1. History
2. Examination
3. Appropriate Invetsigation

23

How is an Acute Flare up of Gout managed?

1. NSAID's
2. Cochicine
3. Steroids (I/A, I/M, Oral)

24

When is the Hyperuricaemia of Gout managed?

1. Single attack of Polyarticular Gout
2. Tophaceous Gout
3. Urate Calculi
4. Renal Insufficiency
5. 2 x attacks in 1 year
6. Prophylactically prior to treating certain malignancies
Note - this is not treated if asymptomatic

25

What medications are used to treat the Hyperuricaemia associated with Gout?

1. Xanthine Oxidase Inhibitor (Allopurinol)
2. Febuxostat
3. Uricosuric Agents (Sulphinpyrazone)
4. Canakinumab

26

What are the rules of Lowering Uric Acid Levels?

1. Wait until the acute attack has settles
2. Use Prophylactic NSAID's / Low dose Colchicine/Steroids until Urate Levels are normal
3. Adjust Allopurinol dose according to Renal Function

27

What is the main treatment for Gout?

Adjusting Cardiovascular and Lifestyle Factors

28

Who commonly presents with Pseudogout?

Elderly Females

29

What is the Aetiology of Pseudogout?

1. Idiopathic
2. Familial
3. Metabolic

30

How does Pseudogout present?

1. Erratic flares, triggered by:
1. a) Trauma
1. b) Intercurrent Illness
2. Chondrocalcinosis (on X-Ray)
3. Pyrophosphate Crystals (on Biopsy)

31

What is the management of Pseudogout?

1. NSAID's
2. I/A Steroids
Note - there are no prophylactic therapies

32

What is Polymyalgia Rheumatica associated with?

Giant Cell Arteritis:
1. 20% of patients with PMR may have evidence of GCA
2. 50% of patients with GCA may have PMR

33

Who is commonly affected by Polymyalgia Rheumatica?

1. Elderly (>50)
2. Females (2:1)

34

How does Polymyalgia Rheumatica present?

1. Sudden onset of Shoulder / Pelvic Girdle Stiffness
2. High ESR (>50)
3. Anaemia
4. Malaise / Weight Loss / Fever / Depression
5. Arthalgia / Synovitis (occasionaly)

35

What is the Differential Diagnosis for Polymyalgia Rheumatica?

1. Myalgic Onset Inflammatory Joint Disease
2. Underlying Malignancy (Multiple Myeloma, Lung Cancer)
3. Inflammatory Muscle Disease
4. Hypo/Hyperthyroidism
5. Bilateral Shoulder Capsulitis
6. Fibromyalgia

36

What is the treatment of Polymyalgia Rheumatica?

1. Steroid - Prednisolone
2. Bone prophylaxis

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