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Session 4 CM Rheum-5
CM- Rheum -5- Crystal Disease
| Question | Answer |
|---|---|
| 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
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