Crystal Arthritis Flashcards
gout and pseudogout (24 cards)
What is found in the blood in patients with gout?
chronically high uric acid levels
What is deposited in the joints of patients with gout?
urate crystals
Describe the typical presentation of gout
a single, acute hot, swollen and painful joint (usually the 1st MTP)
Name the critical differential diagnosis for gout
septic arthritis
What are gouty tophi?
subcutaneous uric acid deposits, usually seen on the hands, elbows and ears
List the risk factors for gout
male sex
family hx
obesity
high purine diet
high alcohol intake
diuretics
CVD
CKD
Name some high purine foods
meat - typically red meat
seafood
What joints are most commonly affected by gout?
base of big toe - MTP
base of thumb - CMC
wrist
What is the emergency management of septic arthritis?
joint aspiration
IV abx
What does aspirated joint fluid show in patients with gout?
monosodium urate crystals that are needle shaped
negatively birefringent of polarised light
What would you see on an x ray of a joint affected by gout?
maintained joint space
lytic lesions in bone
punched out erosions
sclerotic borders
What is the management for acute flairs of gout?
first line - NSAIDs with PPI
second line - colchicine
third line - oral steroids
What class of drug is used for gout prophylaxis?
xanthine-oxidase inhibitors
Name two xanthine-oxidase inhibitors
allopurinol
febuxostat
What lifestyle changes can reduce the risk of gout?
weight loss
staying hydrated
minimising alcohol consumption
reducing intake of purine-based foods
What may occur during the initial period of gout prophylaxis?
this may cause a flair up of symptoms - so NSAID or colchicine cover is recommended
What is deposited in joints in pseudogout?
calcium pyrophosphate crystals
Describe a typical acute presentation of pseudogout
rapid onset hot, swollen, stiff and painful knee in an over 65
Describe a chronic presentation of pseudogout
many patients are asymptomatic
others may present with chronic pain and stiffness in multiple joints
List some joints commonly affected by pseudogout
knee
shoulders
hips
wrists
What investigation should be used to confirm gout and pseudogout?
joint aspiration
What does joint fluid aspiration show in pseudogout?
rhomboid shaped crystals
positively birefringent of polarised light
What x ray changes may be seen in pseudogout?
chondrocalcinosis
calcium deposits show up in a thin white line in the middle of the joint space
What are the management options for pseudogout?
NSAIDs with PPI
colchicine
intra-articular steroid injections
oral steroids
