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25 Cards in this Set

  • Front
  • Back
Gout:

Typical presentation is ... joint swelling with pain and tenderness. Initial attack in 75% of patients is usually in the ... (podagra).

The diagnosis is confirmed by ... and the identification of needle shaped negative ... under polarized microscopy. Joint fluid will show an inflammatory process with elevated PMN’s.
rapid
first toe MTP
arthrocentesis
birefringence
Gout:

... (high uric acid level) is caused by an increased production or decreased excretion.
-Increased production: leukemia, hemolytic anemia, idiopathic, etc.
-Decreased excretion: CRI, ETOH, lead nephropathy, etc.

Remember, that uric acid levels ... confirm a diagnosis of gout.
Hyperuricemia
do not
Is hyperuricemia more commonly caused by overproduction or underexcretion?
underexcretion (90%)
Of the drugs and toxins that can lead to underexcretion (which can then lead to hyperuricemia), which one is the most common? (group and specific drug)
diuretics
hydrochlorothizide
Which substance can cause both overproduction and underexcretion of uric acid?
ethanol
gout epidemiology:

-MOSTLY A DISEASE OF ADULT ....
-PEAK INCIDENCE IN THE ... DECADE
-NOT SEEN IN ...
-PREVALENCE OF 13.6/1000MEN AND 6.4/1000 WOMEN
MEN
FIFTH
PREMEOPAUSAL WOMEN
Asymptomatic hyperuricemia:

-UPPER LIMIT FOR NORMAL SERUM URIC ACID IS 8.0-8.5mg/dl
-IN MALES ADULT LEVELS OF URATE ARE REACHED AT ....
-IN FEMALES THE SAME LEVELS ARE REACHED AT ...
-VAST MAJORITY OF PATIENTS WITH HYPERURICEMIA DO NOT HAVE ...
PUBERTY
MENOPAUSE
SYMPTOMS
Acute gouty arthritis:

-... onset of severe joint inflammation, often with onset in the night
-75% of initial attacks in first ... joint (gout doesn’t affect shoulders)
-Usually ..., may be polyarticular
-Attack subsides in 3-10 days
-... crystals present in synovial fluid
-... may or may not be present
Abrupt
MTP
monarticular
Urate
Hyperuricemia
Chronic Tophaceous gout:
-THIS DEVELOPS 10 OR MORE YEARS AFTER ACUTE INTERMITTENT GOUT
-GOUTY TOPHI CAN BE PRESENT ANYWHERE OVER THE BODY
-TOPHI CAN BE CONFUSED WITH NODAL ARTHRITIS
-Tophi usually present around elbow areas and earlobes


PATHOGENESIS OF HYPERURICEMIA
-... IS THE END PRODUCT OF DEGRADATION OF PURINE COMPUNDS
-RESULT OF LACK OF URIC ACID OXIDASE OR URICASE
URIC ACID
Provocative factors of acute attacks:

-TRAUMA
-Large amount of ... INGESTION (most common)
-DRUGS ( THIAZIDE DIURETICS, LOW DOSE ASPIRIN, ALLOPURINOL)
ALCOHOL
Unusual presentations: Early-onset gout:

-INCIDENCE OF ... IS 80%
-CAUSES INCLUDE BOTH OVER PRODUCTION (usually enzyme deficiency, and most common) AND UNDER EXCRETION OF URIC ACID .
FAMILY HISTORY
Causes of early onset gout:

-... DEFECTS IN THE PURINE PATHWAYS
-GLYCOGEN STORAGE DISEASES
-HEMOGLOBINOPATHIES
-FAMILIAL URATE NEPHROPATHY
ENZYMATIC
... gout:

-HYPERURICEMIA DEVELOPS IN 75-80-%OF PTs WHO TAKE CYCLOSPORIN
-MARKED SHORTENING OF THE ASYMPTOMATIC HYPERURICEMIA
-RAPID DEVELOPMENT OF TOPHI
transplantation
Gout in women:

-UNLIKE MOST RHEUMATIC DISEASES GOUT IS ... IN WOMEN
-90%OF THE WOMEN AT THE TIME OF ATTACK OF GOUT ARE ...
-... women with GOUT HAVE A STRONG HEREDITARY COMPONENT
UNCOMMON
POSTMEOPAUSAL
PREMENOPAUSAL
Radiographic features:

-GOUTY EROSIONS ARE USUALLY ... FROM THE JOINT
-FEATURES INVOLVING BOTH ATROPHY AND HYPERTROPHY WITH ... EDGE
-JUXTA ARTICULAR OSTEOPENIA IS ABSENT OR MINIMAL IN GOUT (seen in RA)
REMOVED
OVERHANGING
-ELEVATED URIC ACID LEVEL IS OF LIMITED VALUE IN ESTABLISHING DIAGNOSIS (never order during acute attack of gout)
-DEFINITIVE DIAGNOSIS IS ONLY BY ... AND INSPECTING SYNOVIAL FLUID
-CYRSTALS ARE USUALLY ... (mostly) OR ROD SHAPED
-A 24 HOUR URIC ACID MEARUREMENT ... REQUIRED IN ALL PATIENTS

-Radiographs are never helpful in ... conditions of gout. It is only helpful in chronic cases
ASPIRATING
NEEDLE
IS NOT
acute
Gout:

... Treatment:
1)NSAIDS (indomethacin)
2)Colchicine
3)Prednisone
4)Intrarticular steroid injection

Chronic Therapy:
1)... – key treatment for chronic therapy (do not use in people on azathioprine)
2)Probenecid
Acute
Allopurinol
...:

-Caused by calcium pyrophosphate dihydrate crystals.
-Can be seen with hemochromatosis, hypothyroidism and hyperparathyroidism. Usually affects the knee initially.
-Arthrocentesis will show rhomboid crystals, weakly positive birefringence.
pseudogout
Pseudogout radiograph:

-... (Calcium deposition within cartilage in joint space) of cartilage and meniscus
-joint space narrowing
-degenerative changes
chondrocalcinosis
... – causes pain, chondrocalcinosis, and arthropathy (monoarticular or oligoarticular)
Calcium PyroPhosphate Dihydrate crystal deposition disease (CPPD or Pseudogout)
CPPD Arthropathy:

Identical to ...

Often occurs in locations not typical for DJD:
-Shoulder
-Elbow
-Radiocarpal joint
-MCP joints
-Isolated patello-femoral joint

Osteophytosis and joint-space narrowing
Degenerative Joint Disease
Pathognomic finding in pseudogout:

Polarized microscopy:
-... positive birefringent crystals
-Typically intracellular
-... in shape
Weakly
Rhomboid
Prevalence of CPPD:

Usually known as a disease of the ...
Recent study looking at radiographic evidence of disease showed:
-Age 65-74---15% had CPPD deposition
-Age 75-84---36% had CPPD deposition
-Age >84---almost 50%

No major sex predominance
elderly
Acute pseudogout treatment:
Removal of crystals by joint ...

NSAIDS or colchicine during ... inflammation

Intraarticular steroids injection
-Ex. Triamcinolone (1mL; 40mg) mixed with 1-2mL 1 percent procaine

Joint immobilization with restriction on weight bearing for 48-72 hours

Oral steroid burst
aspiration
acute
Pseudogout Prophylaxis
-... if >3 attacks per year

Chronic/progressive CPPD crystal deposition
-No proven effective therapy to prevent progressive CPPD crystal deposition or remove crystals deposited
-Probenecid
Colchicine