orthopedics notes

Apr 16th, 2015
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CRYSTALARTHROPATHIES;GOUT ANDPSEUDOGOUTDr Lutomia Mark LumbasiGout Monosodium urate crystal deposition in tissues PMN ingest the crystals Lysosomal enzymes released Men >7mg/dl Women >6mg/dl Usual onset in men > 50yrs Men>womenSpecial circumstances Heart transplants- >75% who take cyclosporine Kidney and liver Transplants-50% Many drugs can tip over patientsdiagnosis Urate crystals in joints Bright negatively birefringent rod and needles in polarizedlight intracellular WBC in synovium high 15-20 000 cells/mm cubedWhat causes gout Urate overproduction 10%Cancers and hemolytic anaemias, pagetsInherited conditions HGPRZT deficiency Incomplete excretion 90%Drugs eg thiazides cyclosporine and ASAHypetentionDiabetesCombined- alcoholClinical scenarios Repeated joint inflammations - tophi formation in joints, bone and soft tissuesurate stones and nephropathyStages of gout Asymptomatic hyperuricemia Acute intermittent attacks- local and systemic Chronic tophaceous goutxray Soft tissue swelling Erosions away from joint with cliff sign Preserved joint spacepathology Foreign body granulomas with macrophages and giantcells surrounding acellular amorphous materialTreatment of goutAcute gout NSAIDS Colchicine SteroidsProphylaxis Colchicine Uricosurics eg probenecid, urate lowering eg allopurinolchondrocalcinosisCause

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