Crystal arthritis

Question 1

Pain and swelling in big toe

Answer 1

Podagra

Question 2

Triggering events in gout attack

Answer 2

Trauma
Dietary/OH excess
Diuretic use/change

Question 3

Risk of gout:

Answer 3

Age, family history, obesity, diabetes, HTN, OH use, acute illness, surgery

Question 4

Calcium pyrophosphase (CPP) crystals are deposited in

Answer 4

articular cartilage

menisci, synovium, periarticular tissues

Question 5

May be used to treat CHRONIC inflammatory CPPD

Answer 5

Hydroxychloroquine, Methotrexate if NSAIDs or Colchisine inadequate

Question 6

Intercritical period in gout is

Answer 6

Asymptomatic periods

Question 7

How likely is another acute attack in the first year after a first attack?

Answer 7

60%

Question 8

Allopurinol side effects

Answer 8

Allopurinol hypersensitivity, NVD, marrow suppression, hepatitis, fever, vasculitis, alopecia

Question 9

CPPD is associated with

Answer 9

aging, hyperparathyroidism, hemochromatosis, trauma, hypophos/hypomag

Question 10

Asymptomatic hyperuricemia begins at

Answer 10

Puberty for men

Menopause for women

Question 11

Clinical presentation of CPPD

Answer 11

Usually mostly asymptomatic

Question 12

Asymptomatic hyperuricemia is associated with

Answer 12

hypertension, hyperglycemia, obesity, hyperlipidemia, CV disease

Question 13

Tophi =

Answer 13

Aggregated MSU crystals

Usually located on ulnar surface of forearms, tendons, olecranon, ear, joints

Question 14

Options for acute gout therapy

Answer 14

colchicine
NSAID
corticosteroids
joint injection if no infection

Question 15

Febuxostate

Answer 15

non-competitive xanthine oxidase inhibitor

Question 16

Joints affected by Acute Gout

Answer 16

MTP, instep, ankles, knees, prepaterllar/olecranon bursae

Question 17

Acute gout is usually ______articular

Answer 17

MONOarticular

Question 18

Allopurinal, Febuxostate are…

Answer 18

Xanthine oxidase inhibitors

Stop purine metabolism, uric acid doesn’t form

Question 19

It is possible for people in an acute attack to have a normal uric acid level

Answer 19

True - 50% will have normal level

Question 20

Acute CPP (pseudogout) presents with

Answer 20

acute/subacute arthritis for several days, monoarthritis (knees, wrists), podagra UNcommon, may follow surg/trauma/illness/diuresis

Question 21

Characteristic Radiology finding of Tophi/Chronic gout

Answer 21

Punched out erosions surrounded by radiodensity

Joint space preservation, normal mineralization

Late disease: punched out lesions with overhanging edges

Question 22

Chronic/tophaceous gout is usually _____articular

Answer 22

POLYarticular

Question 23

Side effects include cardiovascular (MI, CVA), elevated liver transaminases, gout flare

Answer 23

Febuxostat

Question 24

Chronic Kidney Disease is probably d/t

Answer 24

precipitation of uric acid crystals
hypertension
diabetes

Raising SUA induces glom HTN, fibrosis
Lowering SUA may slow CKD progression

Question 25

Presumptive Gout Diagnosis

Answer 25

Rapid, severe pain Pain, erythema, swelling Hyperuricemia

Question 26

Chronic Inflammatory CPPD presents as

Answer 26

polyarticular, symmetric arthritis of small joints in hands/feet

Question 27

What happens when phagocytes ingest crystals?

Answer 27

Lysis and inflammatory response

Question 28

mimics DJD

Answer 28

OA with CPP clinical presentation

Question 29

Risk for kidney stones is _______ to uric acid level (SUA)

Answer 29

proportional

Question 30

Colchicine

Answer 30

Inhibits microtubule formation (turn off cytokine cascade, inhibit NLRP3 assembly)

Question 31

What is released with macrophace lysis?

Answer 31

IL-1, IL-18, cytokines Followed by neutrophil infiltration

Question 32

Management of Gout

Answer 32

Baseline: Ed, diet, lifestyle Look for secondary hyperuricemia causes Acute therapy (colchicine, NSAID, corticosteroids, joint injection if no infection)

Question 33

Diagnosis of CPPD

Answer 33

``` Weakly birefringent, Positive birefringents (aligned blue calcium) Rhomboid crystals, intracellular ```

Question 34

Things that can lead to hyperuricemia

Answer 34

High purine diet Alcohol (beer highest) Fructose cell death ATP -> AMP -> Uric acid

Question 35

XOI alternative

Answer 35

Probenecid

Question 36

Diagnosis of Gout

Answer 36

Demonstrate needle shaped crystal inside cell, Negatively birefringent, Parallel-yellow (plane of polarization) (If the crystal is perpendicular to plane it will be blue)

Question 37

CPPD radiology features

Answer 37

Cartilage calcification (deposition into fibrous/hyaline calcium) Uniform joint space loss No erosions Knees > Hands > Symphasis

Question 38

Uricosuric added to XOI if

Answer 38

XOI not tolerated, under 60, normal renal function, no history of stones, more than 2 attacks/year,