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Flashcards in Crystal Athropathies Deck (24):
1

What is gout?

An inflammatory crystal arthropathy

2

What causes gout?

Deposition of urate crystals within a joint

3

Gout is usually as a result of what?

High serum uric acid levels

(hyperuricaemia)

4

What is uric acid the final breakdown product of?

Purines

(formed in the DNA metabolism involving guanine and adenine)

5

Hyperuricaemia me be caused, or exacerbated by which factors?

  • Renal underexcretion (of uric acid)
  • Diuretics
  • Renal failure
  • Excessive alcohol intake
  • Diet (red meat, seafood)

6

What is the enzyme within the breakdown pathway of purines which can be acted upon by urate lowering therapies?

Xanthine oxidase

(Coverts hypoxanthine to xanthine to uric acid)

7

How is uric acid excreted from the body?

  1. Renal (2/3rds)
  2. GI (1/3rd)

8

Uric acid crystal precipitation in joints can be triggered by what?

  • Dehydration
  • Trauma
  • Surgery

9

Which joints can be affected by gout?

Any joint

Most commonly the first MTP joint, ankle joint, knee joint

10

When gout affects the MTP joint, what is the name of this specific condition?

Podagra

11

How does gout present and what does it mimic?

  1. Intensely painful
  2. Red, hot and swollen

May mimic a septic arthritis

12

What are gouty tophi?

Painless white accumulations of uric acid which can occur in soft tissues and occasionally erupt through the skin

13

If untreated, how long will symtpoms of gout last before resolve?

7-10 days

14

What can chronic gout result in?

Destructive erosive arthritis

15

Describe the process by which a definitive diagnosis is made for gout

A sample of synovial fluid is acquired via joint aspirate

The fluid is examined with polarised microscopy and also with a gram stain (to rule out infective arthritis)

Uric acid crystals are needle shaped and display negative birefringence (yellow to blue) when lined aross the direction of polarisation

16

What is the treatment for an acute gout attack?

  1. NSAIDs
  2. Corticosteroids
  3. Opiod analgesics
  4. Colchicine

17

When would colchicine be administered to a patient for an acute gout attack?

When the patient cannot take NSAIDs

18

What causes pseudogout?

Deposition of calcium pyrophosphate crystals within joints

19

What is the term used to describe when calcium pyrophosphate deposition occurs in cartilage and other soft tissues in the absence of acute inflammation?

Chondrocalcinosis

20

Where does pseudogout tend to affect?

  1. Knee
  2. Wrist
  3. Ankle

21

Which conditions does pseudogout commonly coexist with?

  1. Hyperparathyroidism
  2. Hypothyroidism
  3. Renal osteodystrophy
  4. Haemochromatosis
  5. Wilson's disease
  6. Osteoarthritis

22

Chronic calcium pyrophosphate deposition disease (CPPD) can result in which type of changes in joints?

Osteoarthritic

23

What is the treatment for an acute attack of calcium pyrophosphate deposition disease?

  1. NSAIDs
  2. Corticosteroids (systemic and intra-articular)
  3. Colchicine

24

What is the prophylactic treatment for calcium pyrophosphate deposition disease?

There is no such treatment

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