Gout and pseudogout: Difference between revisions
(Created page with "==Pathophysiology== Monosodium urate (MSU) crystals - needle shaped negative birefringence ==Clinical== Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days...") |
No edit summary |
||
| Line 1: | Line 1: | ||
==Pathophysiology== | ==Pathophysiology== | ||
Monosodium urate (MSU) crystals - needle shaped negative birefringence | Monosodium urate (MSU) crystals - needle shaped negative birefringence | ||
==Clinical== | ==Clinical== | ||
Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days) | Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days) | ||
| Line 17: | Line 11: | ||
Precipitants: purine-rich food, EtOH, trauma, chemo, diuretic use, RI | Precipitants: purine-rich food, EtOH, trauma, chemo, diuretic use, RI | ||
==Diagnosis== | |||
Synovial fluid aspiration (above) | Synovial fluid aspiration (above) | ||
Note: serum uric acid levels unhelpful; ESR/CRP may be elevated | Note: serum uric acid levels unhelpful; ESR/CRP may be elevated | ||
==Treatment== | |||
===Acute=== | ===Acute=== | ||
#Prednisone 50mg po qd for 3-4d and/or triamcinolone 60mg IM x1 | |||
#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) | |||
#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 | |||
#Intraarticular: Methylprednisolone acetate or triamcinolone 40-60mg x1 +/- Bupivicaine +/- Morphine 2-4mg | |||
#STOP thiazide diuretics | |||
===Chronic=== | ===Chronic=== | ||
Allopurinol for urate overexcretors | Allopurinol for urate overexcretors | ||
Probenecid for urate underexcretors | Probenecid for urate underexcretors | ||
==Source== | ==Source== | ||
H-N; EMP | H-N; EMP | ||
[[Category:Ortho]] | |||
[[Category:Rheum]] | [[Category:Rheum]] | ||
Revision as of 23:22, 10 June 2011
Pathophysiology
Monosodium urate (MSU) crystals - needle shaped negative birefringence
Clinical
Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days)
First MTP (podagra) 60% > ankle > midfoot > knee > wrist
May have constitutional complaints
Precipitants: purine-rich food, EtOH, trauma, chemo, diuretic use, RI
Diagnosis
Synovial fluid aspiration (above)
Note: serum uric acid levels unhelpful; ESR/CRP may be elevated
Treatment
Acute
- Prednisone 50mg po qd for 3-4d and/or triamcinolone 60mg IM x1
- 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)
- 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
- Intraarticular: Methylprednisolone acetate or triamcinolone 40-60mg x1 +/- Bupivicaine +/- Morphine 2-4mg
- STOP thiazide diuretics
Chronic
Allopurinol for urate overexcretors
Probenecid for urate underexcretors
Source
H-N; EMP