Gout_Arthropathies Flashcards
- metabolic disease that most often affects middle-aged to elderly men and postmenopausal women
- results from an increased body pool of urate with
hyperuricemia - Characterized by episodic acute arthritis or chronic
arthritis caused by deposition of MSU crystals in joints and connective tissue tophi and the risk for deposition in kidney interstitium or uric acid nephrolithiasis
Gout
- most common early clinical manifestation of gout
- only one joint is affected initially, but polyarticular acute gout can occur in subsequent episodes
- The metatarsophalangeal joint of the first toe often is involved, but tarsal joints, ankles, and knees also are affected commonly
Acute arthritis
first manifestation of gouty arthritis
inflamed Heberden’s or Bouchard’s nodes
first episode of acute gouty arthritis frequently begins at ___with dramatic joint pain and swelling
night
Joints in arthritis rapidly become ___, with a clinical appearance that often mimics that of cellulitis
- warm,
- red, and
- tender
Early attacks of arthritis tend to subside
spontaneously within
3-10 days
Several events may precipitate acute gouty arthritis:
- dietary excess
- Trauma
- Surgery
- excessive ethanol ingestion
- hypouricemic therapy
- serious medical illnesses:
+ myocardial infarction
+ stroke
A proportion of gouty patients may present with a chronic nonsymmetric synovitis, causing
potential confusion with rheumatoid arthritis
Women represent only 5—20% of all patients with gout
- postmenopausal and elderly
- have osteoarthritis
- arterial hypertension that causes mild renal
insufficiency, with diuretics
presumptive diagnosis ideally should be confirmed by ___ of acutely or chronically involved joints or tophaceous deposits
needle aspiration
Present with similar clinical
features
- Acute septic arthritis,
- several of the other crystalline-associated arthropathies,
- palindromic rheumatism,
- psoriatic arthritis
seen both intracellularly and extracellularly during acute gouty attacks
needle-shaped MSU crystals
With compensated light, the needle-shaped MSU crystals are brightly
birefringent with negative elongation
In gouty arthritis, Synovial fluid leukocyte counts are
elevated from 2000 to 60,000/MI
Effusions appear ___ due to the increased numbers of leukocytes
cloudy
s of crystals occasionally produce
a thick pasty or chalky joint fluid