Gout, pseudogout and polymyalgia rheumatica Flashcards
what is gout ?
a syndrome charcterised by hyperuricaemia and deposition of urate crystals leading to attacks of acute inflammatory arthritis, tophi around the joints and possible joint destruction
what is the aetiology of gout?
genetic excessive red meat consumption alcohol xs diuretics leukaemia tumour lysis syndrome (following chemo)
what other diseases is gout associated with?
CVD, HTN, DM, chronic renal failure
what are the S&S of gout?
rapid onset severe joint pain
joint stiffness (esp in morning)
usually monoarticular or oligoarticular (<4)
swelling and joint effusions
Tophi over extensor joint surfaces esp elbow, knees, achilles
tenderness and erythema
Hx of renal stones
what the InV done in gout?
arthrocentesis with synovial fluid analysis
- WBC count around 20,000
- strongly negative biefringent needle shaped crystals under polarised light
serum urate level
- often elevated
US
- erosions, tophi, double contour line
how is acute gout flare managed?
NSAIDs
corticosteroid
colchicine
how is chronic gout managed ?
NSAIDs
allopurinol
- xanthine oxidase inhibitor
lesinurad
- inhibits uric acid transporters
febuxostat
- XOI
probenecid
- excretion of urate in urine
what is pseudogout ?
an inflammatory arthritis that occurs due to calcium pyrophosphate deposition and mimics OA or RA
Typically occurs in older people but can occur in younger people with associated metabolic conditions such as hyperparathyroidism and haemachromatosis
what are the S&S of pseudogout?
painful and tender joints
OA- like joint involvement
- Involvement of joints not typically involved in osteoarthritis such as shoulders, wrists, or metacarpophalangeal joints in a patient with clinical osteoarthritis suggests CPP arthritis
red, swollen tender joints
Joint effusions
what does investigations show in pseudogout?
arthrocentesis with synovial fluid analysis
- Positively birefringent rhomboid shaped crystals under polarised light
- bloody
Joint X-ray
- linear radio opaque deposits in fibrocartilage
- calcified tendons
- subchondral cysts
- joint degeneration
serum calcium
- normal or elevated
what is the treatment of pseudogout?
NSAIDs
intra-articular corticosteroids
colchicine
Cool packs, rest and aspiration for acute flares
MTX and hydroxychloroquine in severe chronic disease
what is polymyalgia rheumatica?
an inflammatory rheumatological syndrome that manifests as pain and morning stifness involving the neck, shoulder girdle and/or pelvic girdle in people >50
what disease can PMR be seen in asociation with?
Giant cell arteritis
what is the S&S of PMR?
shoulder/hip girdle pain and stiffness
- morning stiffness >1 hour
- bilateral
- subacute onset
fatigue, fever and weight loss
tenosynovitis and carpal tunnel syndrome
rapid response to corticosteriods
what do InV show in PMR?
increased ESR and CRP
Bursitis and joint effusion on US
ALP increased in 30%
