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Flashcards in Crystal Athropathies Deck (24)
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1
Q

What is gout?

A

An inflammatory crystal arthropathy

2
Q

What causes gout?

A

Deposition of urate crystals within a joint

3
Q

Gout is usually as a result of what?

A

High serum uric acid levels

(hyperuricaemia)

4
Q

What is uric acid the final breakdown product of?

A

Purines

(formed in the DNA metabolism involving guanine and adenine)

5
Q

Hyperuricaemia me be caused, or exacerbated by which factors?

A
  • Renal underexcretion (of uric acid)
  • Diuretics
  • Renal failure
  • Excessive alcohol intake
  • Diet (red meat, seafood)
6
Q

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

A

Xanthine oxidase

(Coverts hypoxanthine to xanthine to uric acid)

7
Q

How is uric acid excreted from the body?

A
  1. Renal (2/3rds)
  2. GI (1/3rd)
8
Q

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

A
  • Dehydration
  • Trauma
  • Surgery
9
Q

Which joints can be affected by gout?

A

Any joint

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

10
Q

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

A

Podagra

11
Q

How does gout present and what does it mimic?

A
  1. Intensely painful
  2. Red, hot and swollen

May mimic a septic arthritis

12
Q

What are gouty tophi?

A

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

13
Q

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

A

7-10 days

14
Q

What can chronic gout result in?

A

Destructive erosive arthritis

15
Q

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

A

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
Q

What is the treatment for an acute gout attack?

A
  1. NSAIDs
  2. Corticosteroids
  3. Opiod analgesics
  4. Colchicine
17
Q

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

A

When the patient cannot take NSAIDs

18
Q

What causes pseudogout?

A

Deposition of calcium pyrophosphate crystals within joints

19
Q

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

A

Chondrocalcinosis

20
Q

Where does pseudogout tend to affect?

A
  1. Knee
  2. Wrist
  3. Ankle
21
Q

Which conditions does pseudogout commonly coexist with?

A
  1. Hyperparathyroidism
  2. Hypothyroidism
  3. Renal osteodystrophy
  4. Haemochromatosis
  5. Wilson’s disease
  6. Osteoarthritis
22
Q

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

A

Osteoarthritic

23
Q

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

A
  1. NSAIDs
  2. Corticosteroids (systemic and intra-articular)
  3. Colchicine
24
Q

What is the prophylactic treatment for calcium pyrophosphate deposition disease?

A

There is no such treatment

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