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CRYSTAL ARTHRITIS (GOUT (TREAT ACUTE GOUT (Steroids (oral, im, or intra…
CRYSTAL ARTHRITIS
GOUT
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50% occur at the metatarsophalangeal joint of the big toe
Other common joints are the ankle, foot, small joints of the hand, wrist, elbow, or knee.
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Attacks may be precipitated by trauma, surgery, starvation, infection, or diuretics
It is associated with raised plasma urate. In the long term, urate deposits (= tophi, eg in pinna, tendons, joints) and renal disease (stones, interstitial nephritis) may occur.
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RF
Excess Urate Production
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drugs (eg alcohol, warfarin, cytotoxics)
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Dietary (alcohol, sweeteners, red meat, seafood)
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TREAT ACUTE GOUT
Steroids (oral, im, or intra-articular) may also be used
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nb: in renal impairment, nsaids and colchicine are problematic.
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PROPHYLAXIS
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Allopurinol
titrate from 100mg/24h, increasing every 4 weeks until plasma urate <0.3mmol/L (max 300mg/8h).
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Allopurinol may trigger an attack so wait 3 weeks after an acute episode, and cover with regular nsaid (for up to 6 weeks) or colchicine (0.5mg/12h po for up to 6 months).
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Start if >1 attack in 12 months, tophi, or renal stones
It ↓ uric acid by inhibiting xanthine oxidase (se: ↑lfts) and is more effective at reducing serum urate than allopurinol (number of acute attacks the same).
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IX
radiographs show only soft-tissue swelling in the early stages. Later, well-defined ‘punched out’ erosions are seen in juxta-articular bone. There is no sclerotic reaction, and joint spaces are preserved until late.
Needle-shaped monosodium urate crystals found in gout, displaying Negative -birefringence under polarized light.
Pseudogout, showing Positive birefringence in polarized light.
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