crystal arthopathies Flashcards
Define gout.
inflammatory joint disorder cause by hyperuricaemia leading to intra-articular sodium urate crystals
increased purine metabolism causes increased uric acid production which is causative of gout, what causes an increase in purine metabolism?
- increased dietary intake - red meats, red wine
- increased cell turnover - myeloproliferative disorders
- cell damage - post surgery
- cell death - chemo
- reduced excretion - CKD things
- drugs
Renal causes:
- genes
- DM - decreased urate excretion
- diuretics
What defines ACUTE gout?
- presence of monosodium urate crystals in joints
- V painful
Complications of gout?
- HTN
- renal disease
- CVS disease
- T2DM
- OA of the affected joint
Sx of acute gout?
- swollen
- extremely painful joint
- redness
- most commonly big toe MTP joint
- precipitated by excess alcohol, dehydration, diuretic initiation
How does chronic gout Sx differ?
- tophi depositions in and around the joint
- bulkly large smooth white deposits
- toes, fingers, achilles tendon
How does one diagnosis gout?
- clinical Hx and rapid response to NSAIDs/colchicine
- joint aspiration - needle shaped, negatively birefringent crystals
- serum uric acid conc
- U&E for kidney involvment
- X-ray
findings on Xray for gout?
- periarticular joint eroisions
- soft tissue swelling
- normal joint space
Tx of acute gout?
- NSAIDs or colchicine for remission
- lifestyle advice
- steroids - PO, IM or IA
management of chronic gout?
- stop diruetics - ARBs good swap
- lifestyle advice (loose weight, decreased alcohol, decrease red meat)
- allopurionol - urate <300mmol if not increase dose
SEs of allopurinol and colchicine? + contraindications?
allopurinol - skin rash (rarely myalgia + headache)
CI - eGFR <30 close monitoring & azathioprine usage
colchicine - diarrhoea
Hit me with the differences between gout and pseudogout?
epidemiology?
G = middle aged men
P= elederly women
Joints affected?
G=big toe
P= wrist or knee
Crystals?
G= SODIUM URATE - needle shape, negative BRF
P= CALCIUM PYROPHOPHATE - rhomboid, positive BRF
