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24 Cards in this Set
- Front
- Back
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gout epidemiology
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affects 1% of adults, males > females age 30-50
most common form of crystal-induced arthritis and is associated w/ extraarticular manifestations in skin, kidney, elastic cartilage |
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Gout etiology
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disorder of uric acid metabolism >> increased uric acid levels lead to supersaturation of urate and precipitation of MSU crystals in joints and acute inflammatory cascade is initiated
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things that promote crystal formation
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lower body temp (peripheral joints)
repetitive trauma change in hydrostatic pressure ESR |
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inflammatory cascade
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IgG binds crystals >> Complement activated >> PMNs bind crystals via Fc receptor and phagocytose them >> cells rupture >> promotes more inflammatory response
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gout presentation
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Acute pain/swelling in a single peripheral joint that limits motion. Can be precipitated by physical stress.
-Can be gradual onset, especially in elderly |
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gout risk factors
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fam hx, alcoholism, obesity, HTN, CAD, myeloproliferative state, meds like diuretics, IV heparin, cyclosporin
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gout definitive dx
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definitive dx made by presence of MSU crystals engulfed in PMNs in synovial fluid aspirate
-negatively birefringent, needle-shaped crystals that are: yellow under parallel light, blue when perpendicular **EC crystals are not diagnostic |
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gout clinical dx
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less definitive; typical presentation, compatible hx and response to appropriate therapy.
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joint aspirate for gout
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high WBC (can mimic septic arthritis) w/ PMNs 20 to 80K.
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kidney stone
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#1 manifestation; related to serum and urine uric acid and low urine pH
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tophi
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crystalline deposits of urate in subq tissue, tendons, cartilage and soft tissues. Chalklike. Often in ear.
-can be painful periarticular tophi are a late manifestation |
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gout radiographic findings
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early: joint effusion, joint space maintained
late: loss of joint space, tophi are radiolucent |
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principles of gout tx
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aim to reduce inflammatory cytokines, relieve pain, prevent recurrence by decreasing total body urate
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Tx for acute arthritis
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Rest, ice, NSAIDS, oral corticosteroid, cholchicine, steroid injection
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cholchicine
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inhibits PMN microtubule formation and migration and chemotactic factor release.
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how to prevent gout recurrence
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lower serum uric acid levels by decreasing endogenous production and increase urinary excretion
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allopurinol
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decreases endogenous production of uric acid; blocks purine degradation at rate-limiting step (xanthine oxidase); initiated after tx for acute attack.
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probenicid
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blocks renal tubular reabsorption of uric acid and promotes urinary excretion **use in caution w/ pts w/ hx of kidney stone.
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pseudogout
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calcium pyrophosphate deposition that has similar presentation to gout. Less common than gout
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pseudogout epi
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age is greatest risk factor, most common after age 60. only slight predominance for men.
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secondary pseudogout
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due to hyperparathyroidism, hypothyroidism, paget, DM, osteoarthritis
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pseudogout presentation
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acutely painful, swollen joint w/ slower onset compared w/ gout. Less severe than gout and likes the knee, wrist, elbow, pubic symphysis.
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pseudogout dx
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CPPD crystals that are weakly positive birefringement rhomboid shaped crystals engulfed by PMNs; They are positively birefringent, appearing blue when aligned parallel with the slow axis of the compensator and yellow when perpendicular.
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treating pseudogout
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rest, ice, NSAIDS
-colchicine less effective -no maintenance therapy is available |
