Rheumatology 15 - Gout + Pseudogout Flashcards
define gout
crystal arthropathy
high uric acid levels
gouty tophi
DIP joints more affected
risk factors for gout
alcohol
high meat/ fish diet
obese
typical gout joints
MTP - big toe
wrist
base of thumb
can affect knee and ankles but less so
diagnosis of gout - aspiration
no bacteria
needle crystals
negatively birefringent in polarised light
monosodium urate crystals
gout x ray signs x 4
joint space maintained
lytic lesions
punched out erosions
sclerotic borders to erosions
treatment of gout
NSAIDs first
then colchicine
steroids if more needed
allopurinol prophylaxis once resolved
key side effect colchicine
diarrhoea
remember this about allopurinol
don’t initiate until bout of gout resolved
xanthine oxidase inhibitor
define pseudogout
crystal arthropathy
calcium pyrophophate crystals
chondrocalcinosis
typical presentation pseudogout
older adult with hot swollen stiff painful knee
other joints may be hips, wrists, shoulders
can be chronic or asympto
pseudogout aspiration
no bacteria
calcium pyrophosphate crystals
rhomboid shaped
positively birefringenent in polarised light
x ray changes in pseudogout
chondrocalcinosis - diagnostic
LOSS changes as in osteoarthritis
managing pseudogout
no treatment if no symptoms
NSAIDs, colchicine
steroid injection
joint washout if very severe
