Arthritis and Crystal Arthropathy

Question 1

Spectrum of inflammatory arthritis

Answer 1

Question 2

What is the underlying pathophysiology that causes gout?

Answer 2

Elevated serum urate aka hyperuracemia.

Question 3

How does elevated serum urate cause gout?

Answer 3

As urate levels rise body tissues become supersaturated and monosodium urate crystals form in and around joints.

These trigger white cell response and inflammation = clinical gout.

Question 4

Risk factors for hyperuraecemia and gout.

Answer 4

Question 5

Risk factors for acute attacks of gout.

Answer 5

Question 6

What is the clinical presentation of gout?

Answer 6

Question 7

What joints are commonly affected by gout?

Answer 7

Most frequently affected joint is the first MTPJ (first metatarsophalangeal joint).

– Mid-foot, ankle, knee, wrist fingers and elbows.

Question 8

What are tophi?

Answer 8

Question 9

Treatment of gout.

Answer 9

Reduce inflammation and pain Affected joints should be rested, elevated and exposed in a cool environment. Bed-cages and ice-packs can be effective adjuncts to management.

• Non-steroidal anti-inflammatory drugs
• Colchicine
• Corticosteroids

Question 10

What are used as urate lowrering drugs?

Answer 10

Xanthine oxidase inhibitors.

Aim for target serum urate <300 µmols/litre

Question 11

What are the two crystal arthropathy’s?

Answer 11

Gout

Pseudogout

Question 12

Pseudogout

Answer 12

Question 13

Calcium pyrophosphate crystals cause what?

Answer 13

Pseudogout

Question 14

Rheumatoid arthritis

Answer 14

Auto-immune condition more common and severe in women.

Question 15

How does rheumatoid arthritis link to increased mortality?

Answer 15

Increased cardiovascular mortality due to ischaemic heart disease.

Non-Hodgkin’s Lymphoma

Question 16

Clinical features of rheumatoid arthritis.

Answer 16

Question 17

Which joints are commonly affected in RA?

Answer 17

Question 18

Normal vs arthritic joints

Answer 18

Question 19

Key signs of inflammation

Answer 19

Tenderness

Swelling

Erythema

Heat

Question 20

How can the hands be effected in RA?

Answer 20

Question 21

Swan neck deformitiy due to RA

Answer 21

Question 22

What are rheumatoid nodules?

Answer 22

Question 23

How may the organ systems be effected by rheumatoid arthritis?

Answer 23

Ischaemic heart disease

Eyes: Sjorgens syndrome

Scleritis

Skin: Ulceration

Vasculitis

Question 24

What investigations are carried out in RA patients?

Answer 24

• ESR & CRP
• FBC - RA patients can become anaemic.
• U&E & LFT - testing kidney and liver function.
• Urinalysis
• Rheumatoid factor - diagnose and prognosis
• Anti-CCP antibodies - diagnose and prognosis
• Synovial fluid – yellow colouration – Many polymorphonuclear leucocytes

Question 25

What are ESR and CRP tests used for?

Answer 25

The erythrocyte sedimentation rate (ESR or sed rate) and C-reactive protein (CRP) are among the oldest laboratory tests still in use. Both bloods tests are used to detect inflammation in the body.

Question 26

What are the radiological signs of RA?

Answer 26

Juxta-articular osteopenia is the loss of bone around either side of the joint.

Question 27

Treatment of RA

Answer 27

• Education • Physiotherapy • Occupational therapy • Podiatry • Medication • Surgery.

Question 28

Summary of Arthritis and Crystal Arthropathy

Answer 28

* Inflammatory arthritis covers a broad spectrum of conditions. * Chronic joint inflammation can lead to joint damage and loss of function. * Many possible treatment approaches. * Early effective treatment improves outcome.