Crystal Arthopathy Flashcards
Common crystal deposition diseases
Characterised by deposition of mineralised material within joints and peri-articular tissue
Common:
-Monosodium urate - gout
-Calcium pyrophosphate dihydrate (CPPD) - Pseudogout
-Basic calcium phosphate hydroxy-apatite (BCP) – calcific periarthritis/tendonitis
Gout
A syndrome characterised by:
- hyperuricaemia and deposition of urate crystals causing:
- acute inflammatory arthritis
- tophi around the joint and possible joint destruction
- renal glomerular, tubular and interstitial disease
- uric acid urolithiasis
Joints commonly affected by gout
- first toe
- foot
- ankle
- knee
- finger
- wrist
- elbow
Hyperuricaemia overproduction causes
- Malignancy
- Severe exfoliative psoriasis
- Drugs e.g. ethanol, cytotoxic drugs
- Inborn errors of metabolism
- HGPRT deficiency
Hyperuricaemia under excretion causes
- Renal impairment
- Hypertension
- Hypothyroidism
- Drugs e.g. alcohol, low dose aspirin, diuretics, cyclosporin
- Exercise, starvation, dehydration
- Lead poisoning
Management of an acute flare of gout
- NSAIDs
- Colchicine
- Steroids I/A, I/M, oral
Do not treat asymptotic hyperuricaemia
Lowering uric acid levels
- Wait until the acute attack has settled before attempting to reduce the urate level
- Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
- Adjust allopurinol dose according to renal function
Symptoms of gout
- rapid onset severe pain
- joint stiffness
- tenderness
- tophi
- few affected joints
- swelling and joint effusion
Risk factors for gout
- older age
- male sex
- menopausal status
- use of ciclosporin and tacrolimus
- use of aspirin
- adiposity and insulin resistance
- hypertension
- renal insufficiency
- diabetes mellitus
- hyperlipidaemia
Investigations for gout
- arthrocentesis with synovial fluid analysis
- uric acid level
- X-Ray of affected joint
- ultrasound
Pseudogout symptoms
Calcium pyrophosphate deposition (CPPD)
- painful and tender joints
- osteoarthritis-like involvement of joints
- sudden worsening of osteoarthritis
- red and swollen joints
- joint effusion and fluctulance
- fever and malaise
Pseudogout risk factors
- advanced age
- injury
- hyperparathyroidism
- family history of CPPD
- gout
Pseudogout investigations
- arthrocentesis with synovial fluid analysis
- X-rays of affected joints
- serum calcium
- serum parathyroid hormone
Management of Pseudogout
- NSAIDs
- I/A steroids
Polymyalgia rheumatica (PMR)
- An inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle and/or pelvic girdle in individuals older than 50 years
- Peripheral musculoskeletal involvement may be present
- PMR occurs as either an isolated condition or associated with giant cell arteritis
