SM_235a: Crystalline Diseases Flashcards Preview

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Flashcards in SM_235a: Crystalline Diseases Deck (41)
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31

Describe the stages of gout

Gout

  1. Asymptomatic hyperuricemia: 15% will develop gout after 20 years of hyperuricemia
  2. Acute gouty arthritis: 85-90% in a single joint
  3. Intercritical gout (quiescent intervals between gout attachs): 60% have another attack within 24 months, 5-10% never have another attack
  4. Chronic tophaceous gout: after 10 years of uncontrolled disease

32

Describe the acute clinical presentation of gout

Gout acute clinical presentation

  • Acute monoarthritis: usually involving 1st MTP (podagra)
  • Pain often begins very early in morning: very acute
  • First few attacks are often self-limited
  • Subsequent attacks may be more frequent, severe, and resistant to therapy
  • If hyperuricemia persists, the disease can become chronic and polyarticular

33

Chronic tophaceous gout involves deposits in the ____ and _____ in addition to the toe

Chronic tophaceous gout involves deposits in the pinna and elbow in addition to the toe

34

Gout is _____ shaped and _____ when parallel to a polarizer

Gout is needle shaped and yellow when parallel to a polarizer

 

(blue when perpendicular to polarizer, treat with allopurinol)

35

Describe radiographic manifestations of gout

Gout radiographic manifestations

  • Large erosions
  • Punched-out lesions
  • Soft tissue tophi
  • Sclerotic overhanging edges
  • Preserved joint spaces

36

Therapeutic goals for gout are ____, ____, and ____

Therapeutic goals for gout are providing rapid and safe pain relief, preventing further attacks, and preventing formation of tophic and destructive arthritis 

37

First line therapy for gout includes ____, ____, and ____

First line therapy for gout includes NSAIDs, colchicine, and corticosteroids

38

Indications for chronic therapy for gout are ____, ____, ____, and ____

Indications for chronic therapy for gout are > 2-3 gout attacks for 1-2 years, renal stones, tophaceous gout, and erosions on X-ray

39

Describe chronic management of gout

Gout chronic management

  • Xanthine oxidase inhibitors (decrease production of urate): allopurinol (risk for hypersensitivity reactions), febuxostat
  • Uricosuric agents (increase excretion of urate): probenecid (risk for kidney stones), lesinurad
  • Pegloticase: uricase IV, very potent urate lowering agent, immediate hypersensitivity reactions common
  • Anakinra (anti-IL1 biologic therapy)

40

Primary chronic management of gout is _____

Primary chronic management of gout is xanthine oxidase inhibitors (allopurinol, febuxostat)

 

(allopurinol has risk of hypersensitivity reactions)

41

Summarize BCP, CCPD, and gout crystals

BCP, CCPD, and gout crystals

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