CRYSTAL INDUCED ARTHRO II

Question 1

tophi are deposits of?

they are deposits of as a result in excess of?

Answer 1

urate crystals

urate

Question 2

tophi can appear in?

locations?

Answer 2

cartilage
synovial membranes
tendons
soft tissues

fingers, hands, knees, feet, ulnar surfaces like forearm, ear, achilles tendon

Question 3

differential diagnoses of gout?

Answer 3

other crystal induced arthropathies

septic arthritis

trauma

reactive arthritis

RA, if gout is chronic

Question 4

how is gout diagnosed?

Answer 4

joint aspiration
radiographs
ultrasound
labs measuring uric acid, CBC, RF

Question 5

name this type of diagnosis?

Answer 5

under polarized light we see needle shaped crystals with negative birefringence

Question 6

radiographic changes we see in the early stage of gout?

Answer 6

periarticular soft tissue swelling

no osseous changes

Question 7

radiographic changes we see in the chronic stage of gout?

Answer 7

assymetric soft tissue swelling

tophi

erosions with overhanging margins (Martels sign)

joint space preservation

tophis can be intra articular, extra articular resulting in bony destruction; can also be calcified

Question 8

what is the treatment of acute gout?

Answer 8

within 24 hrs of attack preferred

colchicine

NSAIDs

corticosteroids

AcTH

tibial nerve block

Question 9

name this acute treatment med

best used within 36 hours of attack, dosing 1.2mg,
then 1 hour later 0.6mg for a total 1.8 mg and if not improved then may continue 0.6mg 1-2 x per day until symptoms resolve

Answer 9

Colchicine

Question 10

name this acute treatment med

Indomethacin 50 mg TID (three times daily) until pain
tolerated and rapidly taper dose, or 75 mg po one to two times per day until pain tolerated. Usually no more than 2-3 days at this high dosing and toleration of pain.

Answer 10

NSAIDs

Question 11

name this acute treatment med

Intra articular injections to single joint or bursa,
Oral- Prednisone, Medrol Dose Pack, IM or IV

Answer 11

Corticosteroids

Question 12

name this acute treatment med

IM, Patients that cannot
take orals

Answer 12

Adrenocorticotropic Hormone (ACTH)

Question 13

name this treatment acute tx med

elicits sympathetic response

Answer 13

Tibial nerve block with local anesthetic

Question 14

prophylactic gout tx?

Answer 14

used in conjunction with irate lowering agents

colchicine or NSAIDs

Question 15

goal for treatment of gout?

Answer 15

hyperuricemia control

xanthin oxidase inhibitors
-allopurinol
uricosuric agents
-probenecid and sulfinpyrazone
uricases
-krystexxa