lower hyperuricaemia ( lose weight, lower purines in diet, avoid alcohol and cigarettes), symptoms control.
colchicine - 1mg p.o. every 6h in 1st day, every 8h in 2nd, every 12h in 3rd
intraairticular steroids inj. (risk of infection)
chronic: dite, drugs lowering the uric acid level (probenecid - 250 mg 2X a day p.o., allopurinol - 100-300 mg/day)
lab: hyperurycaemia (more than 7.0 mg/dl in males & 6.0 mg/dl in female), high amount level of uric in urine.
synovial fluid: inflammatory character,
monosodium rate (MSU) crystal
imaging: joint space narrowing, bone erosion.
histopathology: test of gouty tophi
chronic disease caused by elevated levels of uric acid in the blood which crystallise and are deposited in joints, tendons, and surrounding tissues.
*Gout attack ( podagra: very intense joint pain, oedema,and red skin, the metatarsal phalangeal joint at the base of big toe is the most commonly affected (50%), also ankle, knee, upper limbs' joints, early in the morning; not treated abates after 10 days - 3 weeks)
*30% of pat. have renal colic attack.
chronic gout - inflammation of many joints, gouty top, renal insufficiency
attack inducing factors:
alcohol, fructose-sweetened drinks, meat, and seafood (purines)
intensive physical effort,
injury or surgery,
drugs (thiazide, loop diuretics, cyclosporine)
course: asymptomatous hyperuricaemia, arthritis attacks, remission periods, chronic gout (tophi)
pseudo gout (calcium pyrophosphate deposition disease)
hyperlipidaemia, septic arthritis, reactive arthritis, injury, bleeding inside the joint, serum sickness disease, early chronic arthritis, osteoarthritis
chonedrocalcinosis (calcium pyrophosphate dihydrate disease (CPPD), pseudo-gout)
disease caused by accumulation of crystal of calcium pyrophosphate dihydrate disease
commonly in older than 65y.o.
- +ve family history.
hormonal disorders - hyper- and hypothyroidism, hyperactivity of parathyroid glands, gout,
hemochrombtosis, hypo- mg/ph emia
joint instability, after meniscus removal, amyloid deposits, biochemical change in cartilage matrix
asymptomatic (commonly), attack similar to gout,
*form similar to rheumatoid arthritis - symmetric disorder of many joints.
*form similar to osteoarthritis - may affect the spine
lab: hyperurycaemia (20%), RF (10%),
synovial fluid examination: inflammatory character, crystal of calcium pyrophosphate dihydrate
imaging: X-ray: crystal deposition in cartilages, tendons, ligaments
attack: effusion removal, drugs - colchicine, NSAIDs, intraarticular steroid inj.
chronic: painkillers (paracetamol, NSAIDs, opioids, intraarticular steroid inj. , physiotherapy
gout - may coexist,
charcot's joints (neurological arthropathy)
causes of chronic arthritis of one joint
infections (mycotic, tb), chronic sarcoidosis, one joint RA or arthritis accompanying intestine inflammation, juvenile arthritis, pigmented villonodular synovitis (PVNS), foreign bodies, synovial chondromatosis