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Session 4 CM Rheum-5

CM- Rheum -5- Crystal Disease

What is the most common form of inflammatory arthritis in men over 40 gout
What is the most common pathogenesis of Hyperuricemia & Gout under excretion 90% and overproduction 10%
What are common causes for overproduction of uric acid GGPRTase/PRPP synthetase, Increased purine intake, alcohol, myeloproliferative disease, psoriasis
What are some common causes for under excretion of uric acid renal defect, Diuretics, Tubular Toxins (alcohol, low dose ASA, cyclosporine), lead, and hypothyroidism
When does incidence of gout in females equal incidence in males after menopause
As people get older and heavier what happens to their chance of developing hyperuricemia and gout it increases
What are the characteristics of stage 1 gout asymptomatic hyperuricemia, no arthritis
What are the characteristics of stage 2 gout acute intermittent arthritis, (period between attack is called the critical period this decreases as condition progresses), Marked by acute attacks involving 1-2 joints increasing to 4-5 as condition worsens toward stage 3
What is a stage 3 gout marked by chronic arthritis with acute exacerbations, Tophi (deposition of uric crystals in bone and cartilage), stage 3 no longer has critical periods as the arthritis is now continuous
What is the first attack of acute gouty arthritis typically called Podagra
What is the best predictor of an acute attack of gout sudden changes in uric acid levels either up and down so be careful when you start allopurinol or you could cause and acute attack of gout
After first attack of gout how many patients will have another attack within 1 year over half (63%)
What type of gout is needle shaped negatively birefringent MSU crystals indicative of Chronic Gout
When are urate lowering therapies indicated tophaceous and recurrent moderate to severe attacks. Also useful for pts about to undergo chemo to prevent acute cell lysis (overloading body with crystals that can cause renal failure) IE don’t use on asymptomatic patients or mild hyperuricemia
What is calcium pyrophosphate deposition disease (CPPD) impaired function of pyrophosphatases leads to deposition of calcium pyrophosphate crystals in joints leading to arthritis
What are the common joints affected by Calcium pyrophosphate deposition disease Knee, Shoulder, Wrist and MCPs
What x-ray findings will you likely find in a pt with calcium pyrophosphate deposition disease linear or stippled calcifications on x-ray
How does CPPD (calcium pyrophosphate deposition disease present Pseudogout, Pseudo RA, Pseudo OA, Pseudo neuropathic joints, asymptomatic chondrocalcinosis
What are the key clinical features of CPPD inflammatory arthritis, with rhomboid weakly positively birefringent CPPD crystals
What medical conditions are associated with CPPD hyperparathyroidism, Hypothyroidism, Hemochromatosis, hypomagnesemia
IF pt has episodic intermittent attacks of arthritis what should you think is causing the arthritis crystals either uric acid crystals or calcium pyrophosphate crystals
When don't you give uric acid lowering agents during acute attacks
Created by: smaxsmith