Gout and Pseudogout Flashcards
What is gout?
inflammation in the joint triggered by negitively bifringent needle shaped uric acid crystals that precipitate in the joints
- too much uric acid!
How is gout diagnosed?
serum hyperuricaemia >0.42 mol increased inflammatory markers polarising microscopy showing negitively bifringent needle shaped uric acid crystals renal impairment X-rays
What is the general presentation for acute gout?
usually MTP joints, or ankle or knee
settles in 10 days without treatment, 3 with
may have normal uric acid during an acute attack
What is the treatment for acute gout?
NSAIDs
Colchine
Steroids
What is the general presentation for chronic gout?
chronic joint inflammation - red and hot
often diuretic associated
What is the treatment for chronic gout?
Allopurinol
febuxostat
When do you commence treatment for chronic gout?
2-4 weeks after an acute attack
What causes too much uric acid production?
enzyme defects - HGPRT deficient, Lysch Nyhan Syndrome
increased cell turnover - cancer, psoriasis
What causes too little uric acid excretion?
drug side effects
thiazide diuretics
What are the secondary changes that gout can cause?
renal disease
gouty tophus
stones and deposition in tubules and intersitium
destructive erosive arthritis
What is pseudogout?
calcium hydroxy appatite or pyrophosphate crystals deposited in the cartilage and around the joints
What populations are affected by pseudogout?
elderly as chondrocalcinosis increases with age
women aged 50-60
What is released in pseudogout?
serine proteases, collagenases and IL-1
What is the treatment for pseudogout?
Physiotherapy NSAIDs arthroplasty IA steroid injection - often an incidental finding on Xray
What does pseudogout commonly coexist with?
hyperparathyroidism hypothyroidism renal osteodystrophy haemochromatosis Wilson’s disease
