Crystal Arthritis

Question 1

What is crystal arthropathy?

Answer 1

Arthritis caused by crystal deposition in joint lining

Question 2

What is crystal arthropathy?

Answer 2

Arthritis caused by crystal deposition in joint lining

Question 3

What can the crystals be made from?

Answer 3

• Urate
• Calcium pyrophosphate
• Hydroxapatite

Question 4

What makes up the crystals in gout?

Answer 4

Monosodium urate

Question 5

What do monosodium crystals look like?

Answer 5

Negative birefringent needles

Question 6

How are the monosodium urate crystals formed in gout?

Answer 6

• Purines are converted to uric acid via xanthine oxidase

- Uric acid is converted to monosodium urate

Question 7

What is the normal serum level of urate?

Answer 7

0.3mm/L

Question 8

What happens in the acute inflammation involved in a gout attack?

Answer 8

• Urate crystals activate phagocytes and cause inflammation

Question 9

How long can it take for tophi to resolve?

Answer 9

Up to 2 years

Question 10

How long can it take for tophi to resolve?

Answer 10

Up to 2 years

Question 11

What can the crystals be made from?

Answer 11

• Urate
• Calcium pyrophosphate
• Hydroxapatite

Question 12

What makes up the crystals in gout?

Answer 12

Monosodium urate

Question 13

What do monosodium crystals look like?

Answer 13

Negative birefringent needles

Question 14

When should you consider pseudogout might be metabolic disease?

Answer 14

If presentation is similar but seen in a younger person

Question 15

What is the normal serum level of urate?

Answer 15

0.3mm/L

Question 16

What happens in the acute inflammation involved in a gout attack?

Answer 16

• Urate crystals activate phagocytes and cause inflammation

Question 17

What are Tophi?

Answer 17

They are seen in long term deposition and are onion like aggregates of urate crystals with inflammatory cells

Question 18

How long can it take for tophi to resolve?

Answer 18

Up to 2 years

Question 19

What are the crystals made of in pseudogout?

Answer 19

Calcium pyrophosphate crystals

Question 20

What joints usually present with pseudogout?

Answer 20

Knee > wrist > shoulder > ankle > elbow

Question 21

How is pseudogout usually discovered?

Answer 21

by accident in other xrays

Question 22

What things are likely to trigger an acute attack in pseudogout?

Answer 22

• Direct trauma to the joint
• Intercurrent illness
• Surgery
• Blood transfusion

Question 23

When should you consider pseudogout might be metabolic disease?

Answer 23

If presentation is similar but seen in a younger person

Question 24

How would you describe the crystals in pseudogout?

Answer 24

Rhomboid shaped and positive birefringent

Question 25

What is the long term treatment for gout?

Answer 25

Aim - urate <0.3mmol/L Non pharma - lose weight etc. Withdraw drugs e.g thiazides Allopurionol! - xanthine oxidase inhibitor

Question 26

What is the presentation of gout?

Answer 26

- Hot swollen joints - Common joints: 1st metatarsal of big toe - - Pain - May be polyarticular but typically monoarticular

Question 27

What is the presentation of psuedogout?

Answer 27

- Normally monoarticular not poly - Severe pain - Stiffness - Swelling - Fever - Resolution in 1-3 weeks

Question 28

What is the presentation of metabolic disease?

Answer 28

- Early onset <55 - Polyarticular - Frequent recurrent attack

Question 29

Why would you aspirate the joint?

Answer 29

To rule out septic arthritis

Question 30

What would you see on the xray in gout?

Answer 30

B - Bony hooks E - Erosions T - Tophi S - Space intact

Question 31

What would you see in the xray with pseudogout?

Answer 31

Chondrocalcinosis - linear calcification parallel to articular surfaces

Question 32

What would you see on the U&E for gout?

Answer 32

- Might be normal in an acute attack | - Can be used to exclude a diagnosis if serum uric acid is in the lower half of normal range

Question 33

What is the acute treatment for gout?

Answer 33

- NSAIDs - Colchicine - Corticosteriodss

Question 34

What is the long term treatment for gout?

Answer 34

Aim - urate <0.3mmol/L Non pharma - lose weight etc. Withdraw drugs e.g thiazides Allopurionol! - xanthine oxidase inhibitor

Question 35

What is the treatment for psuedogout?

Answer 35

Similar to gout | acute = NSAIDs, aspiration of joint, injection of joint, physio