GOUT: CPD review

[liveonearth]

common
deposition of monosodium urate crystals in joints and tendons
dt supersaturated hyperuremic body fluids

ETIO
assoc w/ sycotic miasm, tendency to deposit things
increased production of uric acid (primary) assoc w/ enzyme defects
increased production (secondary) dt myeloproliferative dz, chronic hemolytic anemia, psoriasis
increased dietary purine intake: FOODS HIGH IN PURINE: red meats, organ meats, smoked meats (bacon), mackerel, herring, anchovies, mussels, shrimp, scallops, poultry, peas, beans, lentils, wheat, oats
apparently alcohol increases absorption? is somehow implicated.
decreased renal excretion dt: lead nephropathy, acute ethanol ingestion, toxemia of pregnancy, salicylates, diuretics
MAY BE PRECIPITATED
by minor trauma, overindulgence in food/alcohol, surgery
fatigue, stress, infection

ON PURINE
double-ringed, crystalline organic base
C5H4N4
from which is derived the nitrogen bases adenine and guanine (in DNA)
uric acid = metabolic end product
compounds structurally related to purine: esp adenine and guanine, incl: caffeine, uric acid, theobromine, theophylline

INCIDENCE
males over 30, mb 50, 60
5% of pts are female and most are post-menopausal

SX
onset usually acute, nocturnal
pain progressively worse, described as throbbing, crushing, excruciating
affected joints swollen, skin red, shiny warm, tense, exquisitely tender
metatarsophalangeal joint of big toe most commonly affected
may deposit on ear, instep, ankle, wrist, elbow
1st attack usu 1 joint, subsequent may involve several
may develop fever, tachycardia, chills, malaise, leukocytosis
1st attack lasts a few days, later attacks weeks
chronic joint sx may cause erosion and irreversible deformity

DX
usu increased uric acid but this alone is not diagnostic
urate crystals in joint
may be visible on x-ray (if progressed)

Allo TX:
colchicine

Nat TX:
cherries, blueberries
avoidance of purine rich foods not very effective per Dr T
50/50 tincture of colchicine and berberis, colchicine is toxic so only for acute tx


PSEUDOGOUT
is something else entirely
dt calcium pyrophosphate dihydrate (CPPD) deposition
dt degenerative or matbolic change in cartilage
in elders
acute or subacute attacks
usu larger peripheral joints, esp knee, shoulder too
may have complete freedom between attacks or may persist for life
LABS: Calcium, PTH
DX: CPPD crystals in synovial fluid are diagnostic