crystalline arthropathy (gout) Flashcards
what is gout
uric acid (monosodium urate) deposits in soft tissues, joints and bones
6 diseases that causes secondary hyperuricemia
lymphoproliferative disorders
psoriasis
CHF
CKD
preeclampsia
dehydration
4 drugs causing secondary hyperuricemia
thiazides
furosemide
aspirin
teriparatide
chemotherapy
+ pyrazinamide & ethambutol
when can you treat asymptomatic hyperuricemia with urate-lowering agents
persistent in the infrequent patient with serum urate over 13 mg/dl (men) or 10 mg/dl (women)
severe, sudden, disabling symptoms with intensity by 12-24hrs and resolves in days to weeks +/- treatment
acute gouty arthritis
which condition has predilection to LE, with MTP being the first joint then midfoot then ankle?
acute gouty arthritis
some predisposing/triggering factors to gout (5)
- trauma
- surgery
- starvation or dehydration
- dietary overindulgence
- drugs that raise or lower serum urate–allopurinaol, uricosuric agents, thiazide or loop diuretics, low dose aspirin
of these 7 things, we need 6+ points to be able to make clinical diagnosis of gout.. list the 7 things.
- serum uric acid over 5.88 = 3.5 pts
- first MTP joint = 2.5 pts
- male = 2
- previous attack = 2
- HTN or a CVD = 1.5 points
- joint redness = 1 point
- onset w/in one day = 0.5 point
what is the condition?
on microscopy– negatively birefringent needle-shaped crystles with increased WBC count (under 50K)
gout
confirmatory diagnostic test for both gout and pseudogout
arthrocentesis
what stage of gout
asymptomatic between attacks but will likely have second attack w/in 2 yrs if untreated
might end with chronic tophaceous gout if untreated
intercritical gout
Gout crystals anywhere in soft tissue deep in skin. you poke it and it comes out like toothpaste
tophaceous gout
first line tx of acute gout? who can’t get this treatment? if they cant get it then what?
- ist line: high dose NSAID
- NSAID C/I: renal insufficiency, active DU or GU, CVD
- instead give them steroids (intraaricular if under 2 joints or oral prednisone 30-50mg, taper over 10 days)
when is colchicine used in gout? (2) when is it avoided? (1)
- acute: if its worked in the past and they can’t use an NSAIDs; works weakly in acute cases though
- can also be used as 2nd line in chronic gout
- avoid in kidney disease
ADR of diarrhea, bone marrow suppression (neutropenia)
colchicine
what is the condition
radiograph shows punched out erosions with sclerotic & overhanging margins– mouse/rat bite lesions
gout– bone resorption secondary to tophi formation in the bone
2 renal complications of hyperuricemia
renal stones/urolithiasis
chronic urate nephropathy
6 indications fo urate-lowering therapy
- recurrent gouty attacks that affect patients life
- tophaceous gout
- renal stones d/t uric acid (24 hr urine to confirm)
- very high uric acid levels
- urate nephropathy
- tumor lysis syndrome
what is the treatment target for uric acid when doing urate lowering therapy
below solubility of 6 mg/dL
- xanthide oxidase inhibitor that causes decreased production of uric acid; first line prophylaxis for gout
- prevents urate nephropathy from tumor lysis syndrome
- Start w/ 100 mg daily when renal function above 40 & increase slowly
allopurinol
ADR of rash, leukopenia or thrombocytopenia, diarrhea, drug fever
allopurinol
what are the two urosurics not on our med list but can be used for chronic gout; C/I in renal failure & urate overproducers
probenecid
sulfinpyrazone
clinical manifestations that happen bc of CCP deposition into cartilage of joints
calcium pyrophosphate deposition disease (CPPD)
incidental finding of chondrocacinosis on radiograph or genu varus on P.E
asymptomatic CPPD
