Crystal Arthropathies Flashcards
clinical features of gout
hyperuricemia acute monoarticular arthritis acute polyarticular arthritis tophi and crhonic arthritis nephrolithiasis (kidney stones)
comorbidities of gout
HTN CV disease chronic kidney disease diabetes dyslipidemia metabolic syndrome
lifestyle risk factors of gout
obesity
diet rich in meat and seafood
alcohol
high-fructose corn syrup
medication risk for gout
thiazide diuretics
low-dose aspirin (affect urate excretion)
cyclosporine
nicotinic acid levodopa
(affect urate excretion)
demographic factors for gout
advanced age
male
post-menopause women
primary and secondary causes of hyperuricemia
primary: mostly underexcretion
secondary:
overproduction; lymphoproliferative disorders, hemolytic anemias, psoriasis (increased skin cell turnover)
under-excretion: chronic renal failure, hypothyroidism, tubular poisons and diseases
uric acid is a byproduct of ______
dietary DNA and DNA degradation
where is uric acid excreted?
2/3 from kidneys
1/3 from stomach
if you see calcium deposits within the cartilage, suspect ____
pseudogout
how to Dx gout
never on serum uric acid level alone
low sensitivity and specificity
serum urate decreases during an acute flare (crystals are not measured)
serum urate should be measured 2 weeks after an acute attack
investigations for gout
CBC - neutrophils
joint aspirate
crystal studies
gout crystals are _____ birefringent
negatively birefringent
yellow when parallel to the line of compensation
imaging features of gout
rat bite erosion
large erosions with overhanging edges
cloudy due to overlying tophus
Tx for acute gout
NSAID + PPI
or
colchicine
or corticosteroids
optimize weight, exercise, modify diet, reduce EtOH
Tx for chronic gout
uric acid lowering Tx with allopurinol, febuoxostat or probenecid
optimize weight, exercise, modify diet, reduce EtOH
