Gout and pseudogout: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Monosodium urate (MSU) crystals - needle shaped negative birefringence | Monosodium urate (MSU) crystals - needle shaped negative birefringence | ||
===Precipitants=== | |||
#purine-rich food | |||
#EtOH | |||
#trauma | |||
#chemo | |||
#diuretic use | |||
#RI | |||
==Clinical== | ==Clinical== | ||
Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days) | #Swelling, redness, warmth evolving RAPIDLY over <12 hours (to days) | ||
#First MTP (podagra) 60% > ankle > midfoot > knee > wrist | |||
First MTP (podagra) 60% > ankle > midfoot > knee > wrist | #May have constitutional complaints | ||
May have constitutional complaints | |||
==Diagnosis== | ==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 | ||
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===Chronic=== | ===Chronic=== | ||
Allopurinol for urate overexcretors | #Allopurinol for urate overexcretors | ||
#Probenecid for urate underexcretors | |||
Probenecid for urate underexcretors | |||
==Source== | ==Source== | ||
Revision as of 23:23, 10 June 2011
Pathophysiology
Monosodium urate (MSU) crystals - needle shaped negative birefringence
Precipitants
- purine-rich food
- EtOH
- trauma
- 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)
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