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Yr3 MSK COPY > Crystal Arthropathy > Flashcards

Crystal Arthropathy Flashcards

1
Q

Define Crystal Arthropathies?

A

Any arthropathy involving deposition of mineralised material in joints or periarticular tissue
I.e. Gout & Pseudogout

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2
Q

What is deposited in joints in Gout?

A

Monosodium Urate, crystals of Uric Acid

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3
Q

Describe the physiological passage of urate?

A

2/3rd plasma urate comes from purine breakdown
1/3rd comes from diet

Its then cleared mostly by the kidneys and some by the biliary tract

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4
Q

What are some causes of over-production of Urate?

A
  • Malignancy
  • Severe Exfoliative Psoriasis
  • Drugs e.g. Alcohol
  • HGPRT deficiency
  • Inborn Metabolic errors
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5
Q

What are some causes of under-excretion of urate?

A 
Renal Impairment (main cause for gout)
HYpertension
Hypothyroidism
Drugs e.g. Aspirin, alcohol, diuretics & cyclosporin
Lead poisoning
Exercise, starvation or dehydration
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6
Q

What is HGPRT deficiency also known as?

A

Lesch Nyan Syndrome

An X linked recessive disorder

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7
Q

How does Lesch Nyan Syndrome present?

A 
Intelectual disability
Aggresive/Impulsive behaviour
Self-mutilation
Gout
Renal Disease
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8
Q

How does Gout present?

A

Swelling/nodules on joints
Red, hot and painful oints

Most commonly in the toe

The overlying skin may peel

May see white chalkish material under the skin/breaking through

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9
Q

Who gets gout?

A

Older men mostly.

Women increase in incidence a lot as they age

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10
Q

Why do older women get so much more gout than younger women?

A

Oestrogen is Uricosuric (i.e. helps excretion) so post-menopausal women get lots of gout

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11
Q

What are the risk factors for gout?

A
  • Hypertension
  • Alcohol
  • Obesity
  • High Cholesterol
  • Smoking
  • Diabetes
  • Shellfish (purine rich)
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12
Q

How do we test someone to confirm gout?

A

Needle aspiration of the swollen joint:

  • Cultures to rule out septic arthritis
  • Polarising Microcospy to see the crystals & so confirm gout
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13
Q

What test is useful for managing chronic disease?

A

Uric Acid blood test

Not useful acutely but good for monitoring chronic levels and effectiveness of treatment

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14
Q

How can we manage an acute flare up of gout?

A

NSAIDs (Colchicine if NSAIDs not tolerated)

Steroids (Oral/IM/IA)

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15
Q

How do we manage long-term Hyperuricaemia?

A

1st line - Xanthine Oxidase Inhibitor (Allopurinol)

2nd line - Uricosuric agents e.g. sulphinpyrazone or probenecid

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16
Q

What should you do when starting or increasing allopurinol?

A

Give prophylactic NSAIDs or Colchicine/Steroids.

As allopurinol can actually trigger gout

17
Q

When would we treat hyperuricaemia?

A

Only if:

  • Tophaeceous (i.e. large crystals)
  • Polyarticular
  • Urate Calculi
  • Renal Insufficiency
  • 2nd attack in 1 yr

Never treat if asymptomatic

18
Q

What crystals are deposited in pseudogout?

A

Calcium Pyrophosphate Dihydrate (CPPD)

19
Q

Who gets Pseudogout?

A

Elderly women, mostly in the knee

20
Q

What causes Pseudogout?

A

Triggered by trauma e.g. a fall or an interurrent illness

21
Q

How does pseudogout present?

A

Acutely swollen joint usually after a fall

22
Q

How do we test for pseudogout?

A

X-ray can be useful to see chondrocalcinosis in the joint

Needle aspiration to see CPPD crystals confirms q

23
Q

how to treat pseudogout?

A

NSAIDs

IA steroids

24
Q

What is Polymyalgia Rheumatica?

A

Condition involving stiffness and inflammation in the shoulder and pelvis

Often associated with GCA

25
Q

How does PR present?

A 
Sudden onset shoulder +/- pelvic girdle stiffness
High ESR
Anaemia
Malaise & WEight loss
Fever
Depression
~Arthralgia
26
Q

Who gets PR?

A

2F:1M

Usually >70yrs

27
Q

How do we diagnose PR?

A

Patient:
>50yrs
>50 ESR
REsponds DRAMATICALLY to Steroids

28
Q

DDX for PR?

A 
Malignancy (Multiple myeloma or lung cancer)
Hypo/hyperthyroidism
Inflammatory muscle disease
Bilateral Shoulder Capsulitis
Fibromyalgia
29
Q

How do we treat PR?

A 
CCS for 18-24 months
Bone prophylaxis (Ca, Vit D & Bisphosphonates)

Yr3 MSK COPY (38 decks)

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