PMR & Crystals Flashcards
What are the different crystal deposition diseases?
- Gout
- Pseudogout
What is gout?
Inflammatory crystal monoarthropathy caused by deposition of monosodium urate crystals
What is the presentation of gout?
- Heat (calor)
- Pain (dolor)
- Redness (rubor)
- Swelling (tumour)
- The above symptoms tend to occur in the MTPJ joints in 50% of patients
Why does hyperuricaemia occur?
Under excretion:
- Renal impairment
- Lesch-Nyhan syndrome
- Excess alcohol
- Exercise, starvation, dehydration
- Lead poisoning
How is an acute attack of gout managed?
- NSAID’s
- Colchicine
- Steroids
How is an attack of hyperuricaemia managed?
1st attack:
- Not treated unless:
- Renal insufficiency
- Urate calculi
- Single attack of polyarticular gout
- Treat if 2nd attack within 1 year
- DO NOT treat asymptomatic hyperuricaemia
What are the signs and symptoms of polymyalgia rheumatica?
- Sudden onset of shoulder +- pelvic girdle stiffness
- ESR > 45
- Anaemia
- Malaise
- Weight loss
- Fever
- Depression
What is the association between polymyalgia rheumatica (PMR) and giant cell arteritis (GCA)?
20% of patients with Polymyalgia Rheumatica may have GCA
50% of patients with GCA may have PMR
How is PMR managed?
- Prednisolone 15mg/day for 18-24 months
- Bone prophylaxis
Which joint is most commonly affected in gout?
Metatarsophalangeal joint of the foot
How is gout investigated?
Serum urate
FBC
WCC
U&E’s
Creatinine
GFR
Polarized light microscopy of synovial fluid
What is the difference between gout and pseudogout?
Pseudogout:
- Knee most commonly affected
- Calcium pyrophosphate
Gout:
- 1st MTPJ
- Sodium urate
What other condition is associated with PMR and GCA?
High ESR Anaemia
