Download - CRYSTAL ARTHRITIS-F
-
8/7/2019 CRYSTAL ARTHRITIS-F
1/25
GOUT AND HYPERURICAEMIA
PSEUDOGOUT (PYROPHOSPHATE
ARTHROPATHY)
-
8/7/2019 CRYSTAL ARTHRITIS-F
2/25
AetiologyTwo main types of crystal account for the majority of
crystalinduced arthritis:
-
8/7/2019 CRYSTAL ARTHRITIS-F
3/25
GOUTH
yperuricaemia
-
8/7/2019 CRYSTAL ARTHRITIS-F
4/25
-
8/7/2019 CRYSTAL ARTHRITIS-F
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.
-
8/7/2019 CRYSTAL ARTHRITIS-F
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)
-
8/7/2019 CRYSTAL ARTHRITIS-F
7/25
-
8/7/2019 CRYSTAL ARTHRITIS-F
8/25
Hyperuricaemiaresults frominadequate renal
excretion of uric acidrelative to itsproduction and is
the majordeterminant fordeveloping gout.
-
8/7/2019 CRYSTAL ARTHRITIS-F
9/25
Pathogenesis
-
8/7/2019 CRYSTAL ARTHRITIS-F
10/25
-
8/7/2019 CRYSTAL ARTHRITIS-F
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).
-
8/7/2019 CRYSTAL ARTHRITIS-F
12/25
-
8/7/2019 CRYSTAL ARTHRITIS-F
13/25
Clinical featuresy Hyperuricaemia can cause four clinical syndromes:
-
8/7/2019 CRYSTAL ARTHRITIS-F
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.
-
8/7/2019 CRYSTAL ARTHRITIS-F
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
-
8/7/2019 CRYSTAL ARTHRITIS-F
16/25
In individuals withrenal impairment
or a history ofpepticulceration,alternati
ve treatmentsinclude:
-
8/7/2019 CRYSTAL ARTHRITIS-F
17/25
Chronic tophaceous gout
-
8/7/2019 CRYSTAL ARTHRITIS-F
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.
-
8/7/2019 CRYSTAL ARTHRITIS-F
19/25
On X-rayPeriarticular depositslead to a halo of
radio-opacity andclearly defined(punched out) bonecysts on X-ray.
-
8/7/2019 CRYSTAL ARTHRITIS-F
20/25
PSEUDOGOUT (PYROPHOSPHATE
ARTHROPATHY)
-
8/7/2019 CRYSTAL ARTHRITIS-F
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??
-
8/7/2019 CRYSTAL ARTHRITIS-F
22/25
-
8/7/2019 CRYSTAL ARTHRITIS-F
23/25
In young people it may be associatedwith haemochromatosis,
hyperparathyroidism, Wilsons diseaseor alkaptonuria.
-
8/7/2019 CRYSTAL ARTHRITIS-F
24/25
Diagnosis
-
8/7/2019 CRYSTAL ARTHRITIS-F
25/25
Treatment