Crystal Arthropothy Flashcards

1
Q

What is crystal arthropathy?

A

Deposition of mineralised material within joints and peri-articular tissue

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2
Q

What type of crystals are found in gout?

A

Monosodium urate

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3
Q

What type of crystals are found in pseudogout?

A

Calcium pyrophosphate dyhydrate

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4
Q

What type of crystals are found in calcific periarthritis/tendonitis?

A

Basic calcium phosphate (hydroxy-apatite)

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5
Q

What is a tophus?

A

A deposit of crystaline uric acid

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6
Q

What causes tophi?

A

Massive accumulations of uric acid

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7
Q

Where does the majority of urate come from in the body?

A

Purine degradation

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8
Q

What is the most common cause of gout?

A

Reduced efficency of renal urate clearance

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9
Q

What can cause overproduction of urate?

A
Malignancy
Lymphoproliferative, tumour lysis syndrome
Severe exfoliative psoriasis
Drugs - ethanol, cytotoxic drugs
Inborn errors of metabolism
HGPRT deficiency
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10
Q

What can cause under excretion of urate?

A
Renal impairment
Hypertension
Hypothyroidism
Drugs - alcohol, low dose aspirin, diuretics, cyclosporin
Exercise, dehydration, starvation
Lead poisoning
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11
Q

What is Lesch Nyan syndrome?

A

Deficiency of Hypoxanthine-Guanine Phosphoribosyl transferase (HGPBT) - X-linked recessive

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12
Q

What are clinical features of Lesch Nyan syndrome?

A
Intellectual disability
Aggressive and impulsive behaviour
Self mutilation
Gout
Renal disease
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13
Q

What is the most common demographic of gout?

A

Older men

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14
Q

Why is gout less common in women?

A

Oestrogen leads to lower urate levels

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15
Q

How is acute flare up of gout managed?

A

NSAIDS
Colchicine
Steroids

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16
Q

How is uric acid lowered?

A

Xanthine oxidase inhibitor - allopurinol
Febuxostat
Uricosuric agents - sulphinpyrazone
Canakinumab

17
Q

What are rules for lowering uric acid?

A

Wait until acute attack has settled before attempting to reduce urate level
Use prophylactic NSAIDs or low dose cochicine until urate level normal
Adjust allopurinol dose according to renal function

18
Q

What cardiovascular and lifestyle factors need to be addressed in gout?

A
Hypertension
Smoking
High sugar diet
Alcohol
High fat diet
Obesity
19
Q

What population is most affected by pseudogout?

A

Elderly women

20
Q

What are the 3 main aetiologies for pseudogout?

A

Idiopathic
Familial
Metabolic

21
Q

What are triggers for flareups of pseudogout?

A

Trauma

Intercurrent illness

22
Q

How is pseudogout managed?

A

NSAIDs
Intraarticular steroids
No prophylactic therapies

23
Q

What is polymyalgia rheumatica?

A

Sudden onset of shoulder +/- pelvic girdle stiffness

24
Q

What are clinical features of polymyalgia rheumatica?

A

Anaemia, malaise, weight loss, fever, depression, arthralgia, synovitis

25
Q

How is polymyalgia rheumatica diagnosed?

A
Compatible history
Age>50
ESR>50
Dramatic steroid response
There is no specific diagnostic test
26
Q

What are differential diagnoses for polymyalgia rheumatica?

A
Myalgic onset inflammatory joint disease
Underlying malignancy
Inflammatory muscle disease
Hypo/hyperthyroidism
Bilateral shoulder capsulitis
Fibromyalgia
27
Q

How is polymyalgia rheumatica treated?

A

Prednisolone 15mg per day
18-24 month course
Bone prophylaxis