crystal induced arthritis Flashcards
most common inflammatory disease
gout
essential for the development of gout
hyperuricemia
hyperuricemia clinical definition
> 7.0 mg/dL
uric acid about 7.0 favors
crystal deposition in tissues
the worse the hyperuricemia the
worse the gout
causes of hyperuricemia
- uric acid overproduction
- or underexcretion
gout is more commonly seen in
men in 5th decade
early onset gout is associated often with ____
disease of inborn error of metabolism
common risk factors for gout
- obesity
- alcohol use
- glucose intolerance
- diabetes
- diurectics/ cyclosporin/low dose aspirin
initial presentation of gout
acute mono arthritis with podagra of the 1st MTP
pain gout occurs
very acute in the MORNING, bed sheets cant even touch toe
the first couple of gout attacks are often
self limiting lasting 7-10 d
the only way to make a definitive diagnosis for gout
test synovial fluid
gout in synovial fluid
- inflammatory! WBC >5000 but usually much higher
- fluid may appear purulent and raise concern for septic arthritis
type of crystals in gout
monosodium urate crystals
hallmark of the disease gout
monosodium urate crystals
description of MSU crystals
needle shaped and strongly negative birefringence on polarized light
goal of uric acid in gout
<6 mg/dL
mainstay treatment of gout
NSAIDS - indomethacin
contraindications for NSAIDS in gout
if peptic ulcer disease or renal insufficiency
colchicine therapeutic window
narrow
colchicine toxicity
diarrhea, marrow suppression
colchicine MOA
inhibits neutrophil function
- does not alter URATE LEVELS
amount of colchicine given in acute gout
1.2 mg po followed by 0.6 mg 1 hr later
high doses NOT recommended
