Gout

Pseudogout

o   RF: hyperuricemia (>6.8). Many causes for that: food, TLS, meds, lysh-nyhan…. o   Dx: ·       JOINT ASPIRATION + CRYSTAL IS GOLD STANDARD ·       can be clinical dx ·       The serum uric acid during the acute attack may be normal or low. On the other hand, many people have elevated serum uric acid levels and never develop gout. Thus, the serum uric acid level is of no value in the diagnosis of acute urate arthropathy. o   Tx: ·       Acute: NSAIDs —(can’t, b/c of GI)—> Colchicine —(cant use both or renal impairment)—> Oral steroids  ·       If NSAIDs are not enough? –> Add steroids ·       Chronic: Lifestyle –⤵️ meat, alcohol and so on. —(didn’t work)—> Allopurinol —(can’t  use allopurinol)—> Febuxostat ·        Allopurinol should not be initiated during an acute crisis. However, if a patient has been taking allopurinol and an acute attack occurs, it should not be discontinued (add NSAID)

o   The knee is the most commonly affected joint; o   Radiographs may reveal linear radiodense deposits in joint menisci or articular cartilage (chondrocalcinosis) o   Tx: just like gout (but to prevent: add colchicine)

	Pseudogout
S/S	·        Acute mono-arthritis ·       Severe pain ·       Knee most commonly
Dx	·        Arthrocentesis: Inflammation (15k-30k cells) ·       CPPD Crystals (⊕ Birefringence / Rhomboid Shape) ·       Chondrocalcinosis on imaging
Tx	·        Intra-articular GCS ·       NSAIDS ·       Colchicine

	Gout RF
⤴️	·       Medications (Diuretics, low-dose aspirin) ·       Surgery, trauma, recent hospitalization ·       Volume depletion ·       Diet: High-protein foods (meat, seafood), high-fat foods ·       Heavy alcohol consumption
⤵️	Dairy product intake Vitamin C (21 ,500 mg/day) Coffee intake (26 cups/day)

Prevention of future gout attacks

·       Weight loss: get BMI <25 ·       Low-fat diet ·       ⤵️  red meat intake ·       Avoid Alcohol ·       Avoid diuretics when possible