Crystal arthritis Flashcards Preview

MOHD4: Exam 5 > Crystal arthritis > Flashcards

Flashcards in Crystal arthritis Deck (38):
1

Pain and swelling in big toe

Podagra

2

Triggering events in gout attack

Trauma
Dietary/OH excess
Diuretic use/change

3

Risk of gout:

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

4

Calcium pyrophosphase (CPP) crystals are deposited in

articular cartilage

menisci, synovium, periarticular tissues

5

May be used to treat CHRONIC inflammatory CPPD

Hydroxychloroquine, Methotrexate if NSAIDs or Colchisine inadequate

6

Intercritical period in gout is

Asymptomatic periods

7

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

60%

8

Allopurinol side effects

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

9

CPPD is associated with

aging, hyperparathyroidism, hemochromatosis, trauma, hypophos/hypomag

10

Asymptomatic hyperuricemia begins at

Puberty for men
Menopause for women

11

Clinical presentation of CPPD

Usually mostly asymptomatic

12

Asymptomatic hyperuricemia is associated with

hypertension, hyperglycemia, obesity, hyperlipidemia, CV disease

13

Tophi =

Aggregated MSU crystals

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

14

Options for acute gout therapy

colchicine
NSAID
corticosteroids
joint injection if no infection

15

Febuxostate

non-competitive xanthine oxidase inhibitor

16

Joints affected by Acute Gout

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

17

Acute gout is usually ______articular

MONOarticular

18

Allopurinal, Febuxostate are...

Xanthine oxidase inhibitors

Stop purine metabolism, uric acid doesn't form

19

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

True - 50% will have normal level

20

Acute CPP (pseudogout) presents with

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

21

Characteristic Radiology finding of Tophi/Chronic gout

Punched out erosions surrounded by radiodensity

Joint space preservation, normal mineralization

Late disease: punched out lesions with overhanging edges

22

Chronic/tophaceous gout is usually _____articular

POLYarticular

23

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

Febuxostat

24

Chronic Kidney Disease is probably d/t

precipitation of uric acid crystals
hypertension
diabetes

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

25

Presumptive Gout Diagnosis

Rapid, severe pain
Pain, erythema, swelling
Hyperuricemia

26

Chronic Inflammatory CPPD presents as

polyarticular, symmetric arthritis of small joints in hands/feet

27

What happens when phagocytes ingest crystals?

Lysis and inflammatory response

28

mimics DJD

OA with CPP clinical presentation

29

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

proportional

30

Colchicine

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

31

What is released with macrophace lysis?

IL-1, IL-18, cytokines

Followed by neutrophil infiltration

32

Management of Gout

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

33

Diagnosis of CPPD

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

34

Things that can lead to hyperuricemia

High purine diet
Alcohol (beer highest)
Fructose
cell death

ATP -> AMP -> Uric acid

35

XOI alternative

Probenecid

36

Diagnosis of Gout

Demonstrate needle shaped crystal inside cell, Negatively birefringent, Parallel-yellow (plane of polarization)

(If the crystal is perpendicular to plane it will be blue)

37

CPPD radiology features

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

38

Uricosuric added to XOI if

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