Crystal Disease (Told) - MT Flashcards
(45 cards)
There are 6 types of Crystals that Dr. Told mentioned can cause disease, what are they?
- Monosodium urate (MSU)
- Calcium pyrohosphate dihydrate (CPPD)
- Basic Calcium PO4 (hydroxyapatite)
- Calcium oxalate
- Monoclonal proteins
- Cholesterol crystals
…..Sadistic 6
What type of crystals can deposit in the retina and caue visual field defects and blindness?
- Calcium oxylate crystals
Which is the most common rare crystal type to cause disease?
Calcium phosphate hydroxyapatite
followed by….
calcium oxylate
Cholesterol crystals
monoclonal proteins
Calcium PO4 (hydroxy apatite) deposition causes what?
Do most of these crystals react to polarized light?
calcific tendonitis
no
Calcium oxylate crystals can cause ______ in the spine and hands, and ______ in the kidneys.
- terminal tuft calcification
- nephrolythiasis (stones)
What kind of crystals can be seen in both joint effusions of rheumatoid arthirtis and chronic infection?
Cholesterol lipid crystals
In multiple myeloma, what is the classification of the antibody that is found in the plasma cell rich joint effusions that mediate bone destruction?
S100A4 antibodies
- Describe what you would observe on a birefringent light test in a person with Gout vs. Pseudogout.
- What type of crystals are found in these respective diseases?
- Gout:
Monosodium urate crystals
negative birefringent test
(vertical in plane yellow needles, horizontal blue needles)
- Pseudo-gout:
Calcium pyrophosphate crystals
positive birefringent test
(vertical in plane blue squares, horizontal yellow bodies)
Hyperuricemia and gout appears in about 2-3% of adult male population and incidence in females approach males after menopause. Describe weight and age of the people at risk for or who have this condition.
- obese, increased risk with increased weight
- middle aged males, also increased risk with increased age
With the presence of hyperuricemia, a physician should concurrently invsestigae for what other disease/pathology?
- Cardiovascular disease
(hyperuricemia is a marker for atherogenesis)
especially in patients with other risk factors for Cardiovascular events
Describe the cause of inflammatioon in hyperuricemia.
- urate crystals are coated with IgG antibodies,
***which attract neutrophils, other leukocytes, monocytes, fibroblasts, synoviocytes, renal cells.
All of these cells release cytokines, PGE2, oxygen radicals, and collagenase which cause inflammation
In the pathogenesis of hyperuricemia, what is the most common cause of hyperuricemia? Increased urate production or decreased renal excretion?
90% decreased renal excretion
10% increased urate production
an endocrine disorder that can decrease renal excretion and cause hyperuricemia is?
Hypothyroidism
What substance in a social hx can be abused and cause increased urate production?
ethanol, alcohol
*basically any disease, drug, or process that causes excess cell destruction can cause an increase in urate production and lead to hyperuricemia (10% of the time)
If a patient has a crystal disease, how will he/she most likely describe the timeframe of the pain?
intermittent, episodic attacks
A patient comes in complaining of new onset joint pain in his 1st right metatarsaphalangeal joint, which occurs for a few hours every week since a month ago. He has a history of HTN and hyperlipidemia, and is on a diuretic and statin drug. His birefringent test is negative.
- What is your diagnosis?
- What treatment is most appropriate at this time?
- Acute Gouty arthritis
- NSAIDs or Corticosteroid for acute pain relief, Allopurinol for long term prevention.
-
What would you see in a patient with chronic gouty arthritis? x2
- what is the stage given to this type of gout?
- Tophi
- Polyarticular attacks
- stage III
* acute attacks superimposed
What is a tophi?
deposits of monosodium urate crystals in muscle, cartilage, and bone that appear in stage III gout.
4 indications for urate lowering medication include?
- tophaceous disease with erosions
- uric acid nephrolithiasis
- recurrent attacks depsite prophylaxis
- Chemotherapy (acute cell lysis)
A 80 y/o patient presents with inflammatory arthritis in her left knee, she also has chondrocalcinosis, and is being treated for hyperparathyroidism.
- What is her diagnosis?
- How would you diagnose?
- calcium pyrophosphate depositin disease (CPPD)
- birefringent test, which would be weakly positive for blue rhomboid crystals (pseudogout)
in addition to hyperparathyroidism, what other medical cnoditions are associated with CPPD? x4
- hypothyroidism
- hemochromatosis
- wilson’s disease
- Osteoarthritis
Management of acute crystal disease would include? x4
- NSAIDs (indomethacin)
- Corticosteroids
- colchicine
- IL-1 biologic inhibitor
prophylactic tx of crystal diseases include what 3 categries of pharmaceuticals?
- xantihine oxidae inhibitors like allopurinol and fabuxostat
- Uricosurics (probenicid, losartan)
- Uricases (procloticase)
How would Dr. Told treat each of the respective patients?:
- guy with asymptomatic hyperuricemia
- gal presenting with acute attacks of gout
- prophylaxis of dude with gout
- no treatment but check diuretic use and ASA use and niacin use
- NSAIDs (indomethacin the best), or Corticosteroids if renal function poor
- Allopurinol or fabuxostat or probenecid over skethcy colchine
