Crystal arthropathy

Question 1

How are crystal deposition diseases characterised?

Answer 1

deposition of mineralised material within joints and peri-articular tissue

Question 2

3 common crystal deposition diseases

Answer 2

monosodium urate -> gout
calcium PYROPHOSPHATE dihydrate –> pseudogout
basic calcium phosphate hydroxy-apatite –> calcific periarthritis/tendonitis

Question 3

Gout - appearance

Answer 3

1st MTP joint
acute onset - over night 
red, shiny, acutely painful 
over bony prominences 
white flecks of crystal

Question 4

how long does an attack of gout last?

Answer 4

7 to 10 days

Question 5

Tophus

Answer 5

massive accumulations of URIC ACID

Question 6

source of endogenous uric acid

Answer 6

purine degeneration and diet

Question 7

link between uric acid and gout

Answer 7

hyperuricaemia leads to gout

Question 8

overproduction causes of hyperuricaemia

Answer 8

malignancy 
drugs eg cytotoxic, ethanol 
severe exfoliative psoriasis 
inborn error of metabolism 
HGPRT enzyme deficiency

Question 9

underexcretion causes of hyperuricaemia

Answer 9

renal impairment 
hypertension 
hypothyroidism 
drugs eg alcohol, diuretics
exercise, starvation, dehydration 
lead poisoning

Question 10

Cause of Lesch Nyan syndrome

Answer 10

HGPRT deficiency

Question 11

inheritance of Lesch nyan syndrome

Answer 11

x-linked recessive

Question 12

Symptoms of lesch nyan syndrome

Answer 12

gout 
renal disease 
self mutilation 
aggressive and impulsive behaviour 
intellectual disability

Question 13

risk factors for gout

Answer 13

Henry 8th - HTN, diabetes, obese, cholesterol
sportsman - dehydrated
alcohol
diuretics

Question 14

Prevalence of gout in UK

Answer 14

elderly men
oestrogen helps excrete uric acid
ageing eg diuretics, decreased renal function

Question 15

Investigations for gout

Answer 15

high uric acid blood test? chronic?

ASPIRATION - crystals and exclude infection

Question 16

managing an acute flare of gout

Answer 16

NSAIDS
colchicine
steroids I/A,I/M,oral

Question 17

Side effect of colchicine

Answer 17

diarrhoea

Question 18

When do you treat hyperuricaemia in the 1st attack of gout?

Answer 18

urate calculi
trophaceous gout
single attack of polyarticular gout
renal insufficiency

Question 19

Treating hyperuricaemia in gout

Answer 19

2nd attack in a year

prophylactically prior to treating certain malignancies

Question 20

Do you treat asymptomatic hyperuricaemia?

Answer 20

NO

Question 21

lowering uric acid medications

Answer 21

allopurinol
febuxostat
sulphinpyrazone
canakinumab

Question 22

How does allopurinol work to lower uric acid?

Answer 22

xanthine oxidase inhibitor

Question 23

3 rules for lowering uric acid levels

Answer 23

wait until acute settled before introducing allopurinol
use prophylactic NSAIDS or low dose steroids/colchicine until urate level normal
adjust allopurinol depending on renal function

Question 24

Pseudogout affects what joint?

Answer 24

KNEE

Question 25

Who does pseudogout affect?

Answer 25

elderly females | idiopathic, familial, metabolic

Question 26

triggers for pseudogout

Answer 26

trauma | intercurrent illness

Question 27

Crystals in pseudogout

Answer 27

pyrophosphate

Question 28

Management of pseudogout

Answer 28

NSAIDS | I/A steroid

Question 29

What condition does polymyalgia rheumatica have a strong link to?

Answer 29

GCA

Question 30

Symptoms of polymyalgia rheumatica

Answer 30

sudden onset of shoulder and/or pelvic girdle stiffness anaemia peripheral arthralgia/synovitis malaise, weight loss, fever and depression

Question 31

Who does polymyalgia rheumatica affect?

Answer 31

Females 2: male

Question 32

Is ESR raised in polymyalgia rheumatica ?

Answer 32

yes

Question 33

Diagnosis of polymyalgia rheumatica

Answer 33

compatible history age >50 and ESR >50 dramatic response to steroids in 24-48 hours

Question 34

diff diagnosis for polymyalgia rheumatica

Answer 34

``` polymyositis hyper/hypothyroidism fibromyalgia bilateral shoulder capsulitis underlying malignancy? ```

Question 35

Treating polymyalgia rheumatica

Answer 35

prednisolone 15mg/day initially 18-24 month course DEXA scan and bone prophylaxis