Crystal Induced

Question 1

What is included in crystal induced arthritis?

Answer 1

Gout
Calcium pyrophosphate dihydrate deposition disease
Osteoarthritis

Question 2

Who gets gout?

Answer 2

<65 = men
>65 = men and women

Question 3

What is the MCC of inflammatory arthritis in men >40?

Answer 3

Gout

Question 4

What is gout?

Answer 4

Not an autoimmune
Heterogenous metabolic disorder associated with hyperuricemia cause by:
1. Underexcretion of uric acid
2. Overproduction of uric acid

Question 5

What is uric acid?

Answer 5

A product of purine metabolism

Question 6

MC cause of gout>?

Answer 6

Underexcretion of uric acid

Question 7

Acute inflammation gout gets better in?

Answer 7

10-14 days

Question 8

Chronic inflammatory gout is:

Answer 8

Response leading to continued crystal deposition (tophi)

Question 9

What are acute intermittent gout and chronic gouty arthritis?

Answer 9

Acute intermittent gout&raquo_space; chroinic gouty arthritis

Takes 10 yrs
Joints become uncomfortable and swollen

Question 10

What affects urate overproduction and underexcretion?

Answer 10

ETOH
G6PD
Fructose 1-PAD
HCTZ
Niacin
ASA

Question 11

Clinical manifestations of gout?

Answer 11

Nephrolithiasis (radiolucent)

Tophaceous gout

Skin desquamation

Podagra

Question 12

Diagnostic levels for gout”?

Answer 12

Hyperuricema
- uric acid >/= 6.8 mg/dL
Uric acid nephrolitthiasis
- uric acid >13 mg/dL

Question 13

X rays for gout?

Answer 13

“Rat bite” lesions (late sign)

Question 14

Clinical diagnosis for gout?

Answer 14

Acute monoarticular arthritis

• night pain
• big toe (usually)

Question 15

Hyperuricemia responds to?

Answer 15

NSAIDS

Colchicine

Question 16

Clinical stages of gout?

Answer 16

Stage I: asymptomatic
Stage II: gouty arthritis
Intercriical gout: after attack
Stage III: chronic tophaceous gout

Question 17

Definitive diagnosis of gout?

Answer 17

Uric acid crystals in joint fluid

Polarized microscopy show NEGATIVELY bifringent and needle-like Na urate crystals

Question 18

Uric acid level goal (therapy)

Answer 18

= 6

Question 19

What is the most important aspect of gout tx?

Answer 19

How rapidly tx is initiated

W/in min of flare it may halt progression

Question 20

Gout tx meds?

Answer 20

1. NSAIDS (indomethacin)
2. Colchicine
3. Glucocorticoids (3rd line)

Continue tx 48-72hrs after to reduce risk of relapse

Question 21

How is indomethacin given?

Answer 21

Start at max dose

Question 22

Who gets glucocorticoids (gout)

Answer 22

Reserved for pts who have contraindications to nSAIDS/Colchicine
or
NSAIDS/colchicine are ineffective

Question 23

During an acute gout attack?

Answer 23

Do not start chronic urate lowering drugs during a gout attack

Question 24

Intercrtical treatment of gout?

Answer 24

ULT or cholchicine propolaysis

Question 25

ULT?

Answer 25

Urate lowering drugs (therapy maybe) Xanthine oxidase inhibitors - allopurinol/febuxostat Uricosuric (2nd line) - probenecid >> nephrolitiasis

Question 26

Indications for ULT?

Answer 26

Tophi 2+ attacks/yr CKD stage 2+ Urolithiasis

Question 27

Pseudogout is aka?

Answer 27

Calcium pyrophosphate dihydrate deposition disease

Question 28

Who gets pseudogout?

Answer 28

MC >60y/o

Question 29

What causes pseudogout?

Answer 29

Calcium salt deposits in cartilage (chondrocalcinosis) that precipitate in a joint and cause painful arthritis

Question 30

S/s of pseudogout?

Answer 30

Acute monarticular/oligoarticular arthritis lasting days - 2 weeks

Question 31

Always suspect pseudogout in:

Answer 31

Elderly hospitalized pt with NEW ACUTE MONOARTHRITIS

Question 32

Types of pseudogout?

Answer 32

Primary - idiopathic (aging) - hereditary Secondary - hyperparathyroidism - hemochromatosis - hypothyroidism - hypo Mg2_ and PO4-

Question 33

Lab findings for pseudogout?

Answer 33

Normal serum uric acid Joint aspirate: ca pyrophosphate crystals w POSITIVE bifringence on polarized microscopy

Question 34

Gout vs pseudogout aspirate?

Answer 34

Gout: - negatively bifringent - needle like Na urate crystals Pseudogout: - positive bifringence - Ca pyrophosphate crystals

Question 35

Radiographs for pseudogout?

Answer 35

Calcifications-chondrocalcinosis in knees Signs of degenerative changes (OA)

Question 36

Tx for pseudogout?

Answer 36

NSAIDS/COX2 (1st line) (Same as gout) Corticosteroids (low dose w taper) Colchicine (2nd line) Resistant cases - methotrexate