crystal arthritis-f

8/7/2019 CRYSTAL ARTHRITIS-F

1/25

GOUT AND HYPERURICAEMIA

PSEUDOGOUT (PYROPHOSPHATE

ARTHROPATHY)


2/25

AetiologyTwo main types of crystal account for the majority of

crystalinduced arthritis:


3/25

GOUTH

yperuricaemia


4/25


5/25

Epidemiologyy The prevalence of gout is increasing mainly in

developed countries approximately0.2% in Europe

and the USA.y More inMEN than women (10:1).

y The prevalence in older females is increasing withincreased diuretic use.

y Rarely occurs before young adulthood.


6/25

Hyperuricaemia is defined as aserum uric acid level greater than

two standard deviations from themean (420 mol/L in males, 360mol/L in females)


7/25


8/25

Hyperuricaemiaresults frominadequate renal

excretion of uric acidrelative to itsproduction and is

the majordeterminant fordeveloping gout.


9/25

Pathogenesis


10/25


11/25

Signs andSymptomsAny joints can show signs and symptoms of gout,

including:

yPain.

y Swelling.

y Discolouration.

y Numbness or tingling (Pins and needles).


12/25


13/25

Clinical featuresy Hyperuricaemia can cause four clinical syndromes:


14/25

InvestigationsThe clinical picture is often diagnostic, as is the rapid

response to NSAIDs or colchicine.

yJoint fluid microscopyis the most specific anddiagnostic test but is technically difficult.

y Serum uric acid is usually raised (> 600 mol/L). Ifit is not, recheck it several weeks after the attack, as

the level falls immediately after an acute attack.

Serum urea andcreatinine are monitored for signsofrenal impairment.


15/25

Treat e t indometacin: 75 mgimmediately, then 50 mgevery 68 hours. Although

regarded as the goldstandard treatment bysome, the frequency ofside-effects is unacceptably

high with indometacin. naproxen diclofenac

Caution: NSAIDs may cause renal impairment


16/25

In individuals withrenal impairment

or a history ofpepticulceration,alternati

ve treatmentsinclude:


17/25

Chronic tophaceous gout


18/25

In chronic tophaceous gout,sodium urate forms smoothwhite deposits (tophi) in skinand around joints. They occuron the ear, the fingers or theAchilles tendon.

Large deposits are unsightlyand ulcerate.

There is chronic joint pain andsometimes superimposed acutegouty attacks.

Tophaceous gout is oftenassociated with renalimpairment and/or the long-term use of diuretics.


19/25

On X-rayPeriarticular depositslead to a halo of

radio-opacity andclearly defined(punched out) bonecysts on X-ray.


20/25

PSEUDOGOUT (PYROPHOSPHATE

ARTHROPATHY)


21/25

yCalcium pyrophosphate deposits in hyalineand fibrocartilage produce the radiologicalappearance of chondrocalcinosis.

yShedding of crystals into a joint precipitatesacute synovitis which resembles gout.

How to differentiate??How to differentiate??


22/25


23/25

In young people it may be associatedwith haemochromatosis,

hyperparathyroidism, Wilsons diseaseor alkaptonuria.


24/25

Diagnosis


25/25

Treatment

crystal arthritis-f

Documents