Actual Useful information about Gout Flashcards
The distinctive morphologic changes in gout are what?
(1) acute arthritis,
(2) chronic tophaceous arthritis,
(3) tophi in various sites,
and (4) gouty nephropathy.
What is acute arthritis?
characterized by a dense neutrophilic infiltrate that permeates the synovium and synovial fluid. MSU crystals are frequently found in the cytoplasm of the neutrophils and are arranged in small clusters in the synovium. They are long, slender, and needle-shaped, and are NEGATIVELY birefringent.
What is Chronic tophaceous arthritis?
evolves from the repetitive precipitation of urate crystals during acute attacks. The MSU encrusts the articular surface and forms visible deposits in the synovium (below). The synovium becomes hyperplastic, fibrotic, and thickened by inflammatory cells and forms a pannus that destroys the underlying cartilage and lead to juxtaarticular bone erosions. In severe cases, fibrous or bony ankylosis ensues, resulting in loss of joint function.
What is this?
Tophi are the pathognomonic hallmark of gout. They are formed by large aggregations of urate crystals surrounded by an intense inflammatory reaction of foreign body giant cells.
Tophi may appear in the articular cartilage, ligaments, tendons, and bursae. Less frequently they may occur in soft tissues (earlobes, fingertips) or kidneys. Superficial tophi can ulcerate through the overlying skin.
What are the typical stages of a gout attack?
- asymptomatic hyperuricemia (appears around puberty in males and after menopause in women)
- acute arthritis
- asymptomatic intercritical period
- chronic tophaceous gout
Notes about acute arthritis
presents after several years as sudden onset of excruciating joint pain associated with localized hyperemia, warmth. Constitutional symptoms are uncommon except for occasional mild fever.
Untreated, acute gouty arthritis may last for hours to weeks, but gradually there is complete resolution.
Where do most initial gout attacks occur?
Most first attacks are monoarticular; 50% occur in the first metatarsophalangeal joint.
Eventually, about 90% of affected individuals experience acute attacks in the following locations (in descending order of frequency): insteps, ankles, heels, knees, wrists, fingers, and elbows.
How common is recurrence of acute gouty arthritis?
Resolution of the acute arthritis leads to a symptom free interval. Although some patients never have another attack, most experience a second acute episode within months to a few years.
In the absence of appropriate therapy, the attacks recur at shorter intervals and become more polyartciular
When on average does chronic tophaceous gout develop?
about 12 yrs after initial attack. At this stage, radiographs show chracteristic juxta-articular bone erosion and loss of joint space
