Gout, CPPD, Fibromyalgia, & Raynaud Flashcards
Pathogenesis of gout
Deposition of uric acid crystals in joints, tissues, fluids within body/joint
How is uric acid produced in gout?
Byproduct of purine metabolism (dietary and metabolic)
How do you treat hyperuricemia?
You don’t. Not unless it’s symptomatic b/c doesn’t always lead to gout
Hyperuricemia ≠ gout
Gout is commonly see in what other comorbidities (4)
- Obesity
- HTN
- Diabetes
- Hyperlipidemia
Non-modifiable risk factors of gout
- Male
- African American or Pacific Islander
- Advanced age (esp. postmenopausal)
Modifiable risk factors of gout
- High purine food ingestion
- Obesity
- HTN
- Medications (e.g. HCTZ)
- Toxic exposure to lead
90% of gout is due to _______
Underexcretion
Gout is due to either _______ or _______ of uric acid
Underexcretion or overproduction
Clinical presentation of gout
- Podagra (MTP of big toe)
- Commonly affects feet, ankle, knees
- Joint swelling
- Extremely tender, erythematous → may awaken pt from sleep
Manifestations of chronic gout
- Tophi
- Drainage
- CT destruction, gross deformities
- Infection
- Bone destruction/erosions
- Functional loss
Dx gout
Arthrocentesis → intracellular uric acid crystals w/ negative birefringence
Note - elevated serum uric acid can be misleading (not diagnostic)
24-hr urine in gout pt
- Underexcretors will have normal 24-hr urine
- Overproducers will have elevated level
Early vs. late radiograph findings in gout
- Early → soft tissue swelling, can exclude CPPD or septic changes
- Late → bony erosions w/ sclerotic margins, calcifications
4 categories of gout treatment
- Anti-inflammatory for acute attack (initiate within 24 hrs)
- Anti-hyperuricemic for prevention and reversal of consequences
- Chronic tophaceous gout
Treatment for acute gout flare
- Dietary restrictions
- Initiate therapy within 24 hrs → NSAIDs (e.g. indomethacin), colchicine, corticosteroid, anakinra
- Increase fluid intake, elevate affected extremity
- Treat co-morbidities
- Re-evaluate in 2-4 wks then start chronic tx after rechecking uric acid level
What food should gout pts avoid?
Meat Beans Peas Shellfish Sardines Spinach Alcohol (esp. beer) High fat milk
Gout pts should keep uric acid levels at ______
<5
What drugs should gout pts avoid?
HCTZ
Low-dose ASA
Indications for chronic gout tx
- Multiple or painful attacks of gouty arthritis or radiographic signs
- Tophi or deposits in subchondral bone
- Renal insufficiency
- Nephrolithiasis even after tx
- Urinary uric acid level ≥ 6.5mmol
Pathogenesis of chondrocalcinosis
Ca++ pyrophosphate dihydrate deposition in kidneys & joints
i.e. psuedogout
Risk factors for chondrocalcinosis (3)
- Aging (>60)
- Genetics
- Orthopaedic trauma
Disorders that increase risk of chondrocalcinosis
Hyperparathyroidism Hemochromatosis Hypothyroidism Amyloidosis Hypomagnesemia Hypophosphatemia
Clinical presentation of chondrocalcinosis
- *Valgus deformity of knees
- Erythematous, warm, tender, swollen joint
- Fever possible
- Often co-exist w/ OA
- Can have ligamentum flavum involvement → sx’s mimic meningitis
Dx CPPD
- CPPD crystal deposition
- Positive birefringence**
- Rhomboid shape
- Elevated ESR/CRP
- Radiographic findings of calcified joint cartilage with Ca++ deposits in joint spaces***
