Gout and pseudogout: Difference between revisions

Revision as of 20:48, 27 February 2012

Pathophysiology

Primarily an illness of middle-aged and elderly adults
Most common form of inflammatory joint disease in men >40yr
Presence of crystals does not exclude septic arthritis
Precipitants
- Trauma
- Surgery
- Significant illness
- Change in medication

Clinical Features

Joint pain may develop over period of hours
Primarily involves first MTP, knee, ankle
Constitutional symptoms

Diagnosis

Synovial fluid aspiration
- +crystals, no bacteria on Gram stain
Serum uric acid levels are not helpful (30% of pts w/ gout attack have normal levels)
ESR may be elevated

Treatment

Acute

NSAIDs
1. Do not give to pts w/ renal insufficiency (use opioids instead)
2. Substantial pain relief should occur within 2hr
3. Indomethacin 50mg po TID x3-5d
Colchicine
1. Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function
2. 0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea)

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Pathophysiology==
-Monosodium urate (MSU) crystals - needle shaped negative birefringence
+*Primarily an illness of middle-aged and elderly adults
+*Most common form of inflammatory joint disease in men >40yr
+*Presence of crystals does not exclude septic arthritis
+*Precipitants
+**Trauma
+**Surgery
+**Significant illness
+**Change in medication
-===Precipitants===
+==Clinical Features==
-#purine-rich food
+*Joint pain may develop over period of hours
-#EtOH
+*Primarily involves first MTP, knee, ankle
-#trauma
+*Constitutional symptoms
-#chemo
-#diuretic use
-#RI
-==Clinical==
-#Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days)
-#First MTP (podagra) 60% > ankle > midfoot > knee > wrist
-#May have constitutional complaints
 ==Diagnosis==
-#Synovial fluid aspiration (above)
+*Synovial fluid aspiration
+**+crystals, no bacteria on Gram stain
-Note: serum uric acid levels unhelpful; ESR/CRP may be elevated
+*Serum uric acid levels are not helpful (30% of pts w/ gout attack have normal levels)
+*ESR may be elevated
 ==Treatment==
 ===Acute===
-#Prednisone 50mg po qd for 3-4d and/or triamcinolone 60mg IM x1
+#NSAIDs
-#Indomethacin 50mg po TID for 2d, tapered to 25mg po TID until flare is over OR Naproxen 500mg po bid x 3d and taper over 4-7d (Cr < 1.8mg/dL)
+##Do not give to pts w/ renal insufficiency (use opioids instead)
-#Colchicine 1.2mg po x 1 OR 0.6mg po qh x 3 or 1mg PO f/b 0.5mg q1h until relif, GI  upset, or 8mg  max
+##Substantial pain relief should occur within 2hr
-#Intraarticular: Methylprednisolone acetate or triamcinolone 40-60mg x1 +/- Bupivicaine +/- Morphine 2-4mg
+##Indomethacin 50mg po TID x3-5d
-#STOP thiazide diuretics
+#Colchicine
+##Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function
-===Chronic===
+##0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea)
-#Allopurinol for urate overexcretors
-#Probenecid for urate underexcretors
 ==See Also==
-[[Monoarticular Arthritis]]
+*[[Monoarticular Arthritis]]
-[[Pseudogout]]
 ==Source==
-H-N;
+*Tintinalli
-*EMP
 [[Category:Ortho]]
 [[Category:Rheum]]