Ch 3 - Rheumatology: Crystal-Induced Synovitis Flashcards
Describe the crystals in gout.
Monosodium urate crystals
What does gout affect in joints?
Acute synovitis in the synovial membrane and joint cavity
What is seen on joint aspiration in gout?
Negative birefringence (moderate to severe inflammation WBC 15,000 to 20,000—neutrophils)
Who is affected by gout?
Male»_space; Female
Age: 30 to 50 years
What is the sequale of gout?
- Gouty arthritis
- Acute recurrent attacks
- Chronic tophaceous arthritis
- Uric acid calculi
- Urate nephropathy
Describe the clinical presentation of monoarticular gout.
Exquisite pain, warm tender swelling
What is the MC joint involved in monoarticular gout?
First MTP joint (podagra)
Which joints are involved in monoarticular gout?
First MTP joint Midfoot Ankles Heels Knees
Describe Chronic tophaceous gout.
– Tophi form after several years of attacks
– Cause structural damage to the articular cartilage and adjacent bone
What is involved in polyarticular gout?
Olecranon bursae
Wrists
Hands
Renal parenchyma with uric acid nephrolithiasis
What are provocative factors for gout?
- Trauma—influx of synovial fluids urate production
- Alcohol—increase uric production
- Drugs—thiazides, ASA
- Hereditary
What is seen on labwork in gout?
Hyperuricemia
What is seen on radiographs in gout?
Soft-tissue swelling around the affected joint
What is seen on radiographs in chronic tophaceous gout?
- Tophi appear as nodules in lobulated soft tissue masses
- Bone erosions develop near the tophi just slightly removed from the periarticular surface, developing overhanging margins
What is the treatment of an acute gout attack?
- Colchine—inhibits phagocytosis of the urate crystals
- NSAIDs—Indocin
- Corticosteroids