Gout and Pseudogout Flashcards
Epidemiology of gout
affects males more often
men over 40 and post menopausal women
commonly affects foot and ear d/t temperature difference (colder than core)
Clinical signs of gout
acute onset (like woke up and it was red), painful, swollen, erythematous, monoarticular classically presents in 1st MTP joint
What is a tophus
a soft tissue mass composed of urate
How to differentiate between gout and cellulitis
If you draw a line around redness, gout will not spread beyond that line but cellulitis will continue to spread
Also, gout only affects joints whereas cellulitis can affect areas in between two joints (ex. forearm, shin)
How to dgx gout
Look at aspiration under microscope (with polarization) to see bluish green crystals
Pathophys of gout
deposition of monosodium urate crystals into soft tissues including synovial membranes
radiologic findings of gout
asymmetric soft tissue swelling
tophi
“rat bite” erosions in bone
joint space is often preserved until late in the disease
What tests should you order for gout
check WBC, PMN count
polarized microscopy
ESR (will be elevated)
Serum uric acid levels >7mg/dl (note this value is low during a gout attack)
Tx of gout
Acute: NSAIDs, colchicine, prednisone, intraarticular injection
Chronic: Allopurinal (best tx), probenecid, febuxostat, modify risk factors
Where and who does pseudo gout occur
Elderly
usually knee, wrist, shoulder, polyarticular
Pathophys of pseudogout
Calcium pyrophosphate dihydrate crystals occur
How to differentiate between pseudogout and OA
Pseudogout is hot, red, and swollen
OA is just swollen
Radiographic findings in pseudogout
Because calcium shows up on xray, will see clouding in the joint space above sclerosing of the bone
Tx of pseudo gout
r/o infection NSAIDs colchicine oral prednisone instraarticular steroid injection no chronic therapy needed!
