P2.6 - Metabolic/Crystal Deposition Disorders

Gout

- Hyperuricemia with secondary sodium monourate crystal deposition:

• Cartilage

• Synovium

• Periarticular

• Subcutaneous

Inflammatory

With gout, crystals evoke a strong _____ joint disease

- M:F → 20:1

- 4th/5th decades

State the clinical features of gout

- Asymptomatic hyperuricemia

- Acute gouty arthritis

- Polyarticular gouty arthritis

- Chronic tophaecous gout

State the 4 stages of gout

- Elevated ESR

- Leukocytosis

- Hyperuricemia**

- Joint aspiration

State the lab findings of gout

- Dense soft tissue tophi (swelling)

- Bone erosions

- Overhanging margin sign

- Secondary degeneration

- 1st MTP MC joint

State the radiographic findings of gout

- Rapid recovery within days of the attack

- Moist Heat

- Colchicine

- Allopurinol

- Black cherry juice

State the treatments for gout

- Pseudogout

- >50 y.o.

- M=F

- May be asymptomatic

- Acute inflamed joint

- Bilateral asymmetric

State the clinical features of calcium pyrophosphate dihydrate crystal deposition disease (CCPD)

- Knee

- Symphysis pubis

- Hand/wrist

- Hip

- Shoulder

- Elbow

- Spine

State the target sites of calcium pyrophosphate dihydrate crystal deposition disease (CCPD)

- Soft tissue swelling

- Chondrocalcinosis

- Severe degeneration

- Pyrophosphate arthropathy

- Articular destruction

- SLAC wrist (scapholunate advanced collapse)

State the radiographic findings of calcium pyrophosphate dihydrate crystal deposition disease (CCPD)

- Deposition of calcium hydroxyapatite within a tendon, bursa, or other periarticular soft tissue

- May cause tendinitis, bursitis, and joint pain

State the pathophysiology of calcium pyrophosphate dihydrate crystal deposition disease (CCPD)

- 40-70 y.o.a

- M=F

- Pain, tenderness, localized swelling

- Decreased ROM

State the clinical features of hydroxyapatite deposition disease (HADD)

Calcific tendinitis

Another term for hydroxyapatite deposition disease (HADD)

Supraspinatus

Hydroxyapatite deposition disease (HADD) of the _____

Infraspinatus

Hydroxyapatite deposition disease (HADD) of the _____

Long head of biceps brachii

Hydroxyapatite deposition disease (HADD) of the _____

Longus coli tendon

Hydroxyapatite deposition disease (HADD) of the _____

- 2-5% of the population are heterozygous carriers (Caucasian population)

- MC genetic disorders in Caucasians of Northern European ancestry

• Hyper-pigmented skin "bronze" (90%)

• Hepatomegaly (90%)

• Arthralgia (50%)

• Diabetes (30%)

• Heart failure/arrhythmia (15%)

• M=F (M express earlier)

State the clinical features of hemochromatosis

Sodium monourate

Crystal/substance deposition of gout

Calcium pyrophosphate dihydrate

Crystal/substance deposition of CPPD

Calcium hydroxyapatite

Crystal/substance deposition of HADD

Iron

Crystal/substance deposition of hemochromatosis