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Arthritis Pt 2 - Coggle Diagram
Arthritis Pt 2
gout: caused by accumulation of uric acid crystals in synovial joints
-polymorphonuclear leukocytes attracted to joint, try to engulf crystals. digestive enzymes and proinflammatory mediators are released
Phases of gout:
-asymptomatic hyperuricemia-elevated serum levels of uric acid predispose people to develop gout
-acute gouty arthritis
-intercritical gout (aymptomatic between acute episodes)
-chronic gout-tophi, deposits of uric acid often seen
acute attack:
-typically begins with onset of severe burning pain in middle of night
-usually involves 1st MTP
-weight of bed sheets may be unbearable
-red, swollen, hot to touch
-resolves within 7-10 days
-precipitated by alcohol, trauma, surgery, or immobilization
-any joint can be affected
-most commonly knee, ankle, midfoot, wrist, and hand
-tophi are painless lumpsin chronic gout, often at olecranon, fingers, toes, or outer ear
treatment of acute gout
-cold packs may be helpful
-no other modalities or exercise is recommended
-NSAIDs are mainstay
-oral or steroid injection alternative treatment
-colchicine not generally recommended due to side effects
-cannot be diagnoses by elevated serum levels of uric acid
-<20% of those with elevated levels develop gout
-30% do not have elevated levels at time of flare up
-dx must be made by examining joint fluid
Pseudogout: calcium pyrophsophate crystals initiate inflammation
present similarly to gout, RA (pseudo-RA) or as aggressive OA
calcium deposits can be seen as opacities on radiographs in knee joint space or in TFCC of wrist
-aspiration of fluid often enough to relieve symptoms
-use of NSAIDs or local steroid injection
must be diagnosed by examination of fluid
clinical signs of infected total joint prostheses
acute:
-wound dehiscence, drainage,
-classic signs of infection
later signs:
-pain and loosening of joint may be only signs
REFER BACK TO ORTHOPEDIST
treatement
-if caught early arthroplasty may be salvaged with aggressive lavage or IV antibiotics
-if not caught early or gram-neg bacteria present joint must be removed and often not replaced until after extensive anti-biotic treatment
OA
-most common type of arthritis
-increased prevalence with age
-estimated to affect >80% of those >75 years old
pathologic changes:
-thinning and damage to AC
-subchondral bone sclerosis
-marginal bone and cartilage growth as osteophytes
-periarticular muscle wasting
commonly affected joints
-DIPs (heberden's nodes), PIPs (bouchard's nodes)
-Hips
-lumbar spine
-knees
-feet (especially 1st MTP)
Treatment: none found to stop progression
-minocycline may slow progression by inhibiting metalloproteinases
-one study has shown glucosamine increased joint space in arthritic knee
DDx of single red, hot joint
infection is most dangerous and must be ruled out through synovial fluid testing
Others include:
-acute gout
-hemarthrosis w/ or w/o trauma
-pseudogout
-RA
-seronegative arthropathy
-other less common etiologies (tumor, etc)
gout vs pseudogout
-examination of synovial fluid under polarizing microscope
-uric acid crystals are needle-like, negatively birefringent
-calcium pyrophosphate is rod-shaped, positively birefringent