Rheum Y2 intro Flashcards
2 types of Crystal arthritis
Gout
Pseudogout
what is pseudo gout syndrome caused by?
deposition of calcium pyrophosphate dihydrate = crystal deposition= inflammation
what is gout caused by?
urate crystals caused by uric acid
hyperuricaemia is a risk factor
risk factor for gout?
hyperuricaemia
causes of hyperuricaemia
genetic tendency
increased uptake of purine rich foods
kidney failure- reduced excretion
acute gout characteristics
monosodium urate crystals - due to hyperuricaemia
result in gouty arthritis or trophi
what are trophi
where are they commonly found/
pinna of ear
olecrannon bursa
and MTP joints
white deposits of MSU crystals
metatarsophalangeal joint of the big toe 1st MTP joint
extremely painful, cannot even touch
rapid onset
red, warm,swollen and tender joint
resolves 3-10 days
what are these clinical signs of?
gouty arthritis
acute gout due to monosodium urate crystals
x-ray findings of gout?
MTPJ big toe
bone erosions ‘rate bite’
investigations for gout?
management
joint aspirations
- what do crystals look like? synovial fluid analysis
acute: steroids, NSAIDS, colchine
chronic - allopurinol
how to chronically treat gout?
reduce hyperuricaemia
by use of allopurinol
difference between gout, pseudogout
crystal
shape
birefringence
GOUT
crystal: urate
shape: needle
birefringence : NEG
PSEUDOGOUT
crystal- calcium pyrophosphate dihydrate
shape- brickshaped
birefringence- positive
RA
characteristics
management
worse after rest, morning
inflammatory, small joints, symmetrical
TNFa activated
RF detectable
management
aggressive at beginning, rapid treatment = avoid further destruction of joints
glucocorticosteroids , DMARDS
biologics- janus kinase inhibitors - tofacitinib
