SM_235a: Crystalline Diseases Flashcards Preview

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Flashcards in SM_235a: Crystalline Diseases Deck (41)
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1

All crystalline arthropathies are characterized by _____ and _____

All crystalline arthropathies are characterized by inflammation in the joint and crystals in synovial fluid

2

Describe inflammatory synovial fluid analysis 

Inflammatory synovial fluid analysis

  • Slightly turbid appearance
  • 2,000-50,000 WBCs/mm^3
  • 20-70% PMNs

3

____, ____, and ____ are the main crystal types

Basic calcium phosphate (BCP), calcium pryophosphate dihydrate (CPPD), and monosodium urate (gout) are the main crystal types

4

Basic calcium phosphate crystal are also known as _____

Basic calcium phosphate crystal are also known as calcium hydroxyapatite

5

Basic calcium phosphate (BCP) crystals deposit in _____, _____, and _____

Basic calcium phosphate crystals (BCP) deposit in soft tissue (acute calcific periarthritis), joints (BCP arthropathy), and tendons (calcific tendinitis)

 

  • Soft tissue (acute calcific periarthritis): 1st MTP in young women (pseudo-podagra)
  • Joints (BCP arthropathy): Milwaukee shoulder syndrome
  • Tendons (calcific tendinitis): shoulder, most commonly in supraspinatus tendon

6

Acute calcific periarthritis occurs when BCP crystals are shed from ____ and deposit in ____

Acute calcific periarthritis occurs when BCP crystals are shed from calcific deposit and deposit in soft tissues

 

  • BCP crystals shed from calcific deposit of BCP arthropathy or calcific tendinitis
  • Intense local inflammation

7

BCP causes acute calcific periarthritis of ____ in young women (pseudo-podagra)

BCP causes acute calcific periarthritis of 1st MTP in young women (pseudo-podagra)

8

BCP deposit in ____ causes ____, which is severe degenerative arthritis of the shoulder joint

BCP deposit in joints causes Milwaukee Shoulder Syndrome, which is severe degenerative arthritis of the shoulder joint

 

  • Loss of rotator cuff, cannot abduct arm, huge swelling
  • BCP crystals identified
  • Woman > 70s
  • Bilateral involvement common
  • Can affect other joints such as finger (Philadelphia finger)

9

BCP deposit in joints of the finger causes _____

BCP deposit in joints of the finger causes Philadelphia finger

10

BCP deposits in tendons causes _____, most commonly in tendons of the _____

BCP deposits in tendons causes calcific tendinitis, most commonly in tendons of the shoulder

 

  • Usually in muscles that abduct and stabilize the shoulder
  • Bursitis, impingement syndrome
  • Can also involve hand, wrist, hip, knee, foot, neck

11

BCP appearance on microscopy includes _____, _____, and _____

BCP appearance on microscopy includes shiny coins on ordinary light microscopy, NOT birefringent on polarized light microscopy, and joint aspirate stained for alizarin red

12

BCP is _____ on polarized light microscopy

BCP is NOT birefringent on polarized light microscopy

13

EM of BCP crystals shows _____ in synovial fluid demonstrating _____

EM of BCP crystals shows rice bodies in synovial fluid demonstrating apatite crystals

14

Synovial fluid in BCP crystals is _____

Synovial fluid in BCP crystals is non-inflammatory 

 

(like OA)

15

BCP arthropathy is treated if the patient is _____ and includes _____, _____, _____, and _____

BCP arthropathy is treated if the patient is asymptomatic and includes NSAIDs, PT, intra-articular steroids, and surgery if indicated

16

Describe the ABCs of BCP arthropathy

ABCs of BCP arthropathy

  • A: acute calcific periarthritis, alizarin red stain, atypical gout (young woman)
  • B: BCP arthropathy, NOT birefringent
  • C: calcific tendinitis, cuff (supraspinatus), coins shiny on light microscopy

17

Describe calcium pyrophosphate dihydrate (CPPD) arthropathy

CPPD arthropathy (formerly known as pseudogout)

  • Calcium pyrophosphate deposition in joints
  • Major risk factor is aging: peaks 65-75 years
  • Female to male is 2-7:1
  • Predilecton for joints affected by osteoarthritis
  • Associated with numerous metabolic disturbances: screen if onset of disease < 55 years

18

Check ____, ____, and ____ levels is suspecting CPPD

Check Mg, iron/ferritin, and TSH levels is suspecting CPPD

19

Describe the clinical presentations of CPPD

CPPD clinical presentations

  • Pseudogout (gout mimic): acute monoarthritis (knees > wrist > shoulder > ankle and elbow)
  • Chronic polyarthritis (RA mimic): symmetric, small joints
  • Progressive osteoarthritis: involves large and small joints, crowned dens syndrome (spinal involvement)
  • Asymptomatic chondrocalcinosis

20

CPPD mimics ____ by causing ____

CPPD mimics gout by causing acute monoarthritis

 

(knees > wrist > shoulder > ankle and elbow)

21

CPPD mimics ____ by causing ____

CPPD mimics RA by causing chronic polyarthritis

 

(symmetric, small joints)

22

CPPD with spinal involvement causes _____

CPPD with spinal involvement causes crowned dens syndrome

23

Describe radiographic manifestation of CPPD

CPPD radiographic manifestations

  • Can have chondrocalcinosis without pseudogout and vice versa
  • Meniscus and triangular fibrocartilage of wrist often show classic findings

24

CPPD crystals are ____ and ____ on polarized light microscopy

CPPD crystals are pleomorphic and weakly positive birefringent on polarized light microscopy

 

(look rhomboidal, weak tint)

25

Describe CPPD treatment

CPPD treatment

  • NSAIDs
  • Intra-articular or oral steroids
  • Colchicine: use caution given elderly population
  • Anakinra: not FDA approved
  • Weak data on hydroxychloroquine and methotrexate
  • No true prophylaxis and treat acute gout attach

26

____ and ____ cause non-gout arthropathies

BCP and CPPD crystals cause non-gout arthropathies

 

  • BCP: soft tissue (acute calcific periarthritis) - 1st MTP in young women (pseudo-podagra), joints (BCP arthropathy) - Milwaukee Shoulder Syndrome, tendons (calcific tendinits) - shoulder most commonly supraspinatus tendon
  • CPPD: spectrum of presentations, Crowned Dens syndrome, primary (pseudogout, RA, OA, Charcot, asymptomatic, etc), secondary (check PTH, Ca, P, Mg, TSH levels)

27

Describe gout

Gout

  • Increased prevalence with increased age and increased uric acid
  • [uric acid] rises decades before development of goat
  • Males: onset of puberty -> disease onset > 30 yo
  • Females: perimenopausal phase -> disease onset 60 yo (estrogen is uricosuric)
  • Male predominant disease until menopause after which rates equalize
  • 50% have gout if UA > 10 mg/dl
  • Positive FMHx in 50%

28

Describe risk factors for gout

Gout risk factors

  • Alcohol consumption especially beer
  • Obesity, metabolic syndrome, insulin resistance
  • Diet rich in purines: meat, shellfish, ethanol, soft drinks, high fructose syrup
  • Drugs: thiazide, cyclosporine, low dose ASA (<1 g / day)
  • Renal insufficiency
  • Organ transplantation
  • Inborn errors of metabolism: Lesch-Nyhan, PRPP synthetase

29

Amount of alcohol consumed directly correlates with goat risk because _____ while _____

Amount of alcohol consumed directly correlates with goat risk because increased ATP degradation leads to increase urate synthesis while increased lactic acid leads to decreased urate excretion

 

(beer has highest purine content)

30

Hyperuricemia is primarily caused by _____

Hyperuricemia is primarily caused by underexcretion 

 

(decreased renal function, drugs, alcohol use)

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