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the pathophysiology of joint disease 3: gout (crystal arthritis) $9.83   Add to cart

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the pathophysiology of joint disease 3: gout (crystal arthritis)

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includes: patient case example, epidemiology, common comorbidities, risk factors, medications, effect on daily life, pathophysiology, known triggers, clinical picture, common sites, diagnosis

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  • December 21, 2023
  • 5
  • 2021/2022
  • Class notes
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1
Sunday, 16th January 2022
Week 1
Medicine
The Pathophysiology of Joint Disease 3
Gout (crystal arthritis)
Patient
 Guy
o 35
o Male
 History
o Woke with acute pain in left ankle and pig toe
o Unable to go back to sleep
o Unable to walk
o Previous similar episodes
 Examination
o Internal swelling around the ankle and great toe MTP
o Extends to mid foot
o Redness
o Felt very warm
o Examined all joints and systemic investigation
 Over right thumb had hard swelling
 Nodular
 Creamy and pearly under the skin
 Slowly worsening over the last 12-18 months
 Discharges chalky toothpaste like substance
 Tests
o FBC, U&E - Normal
o CRP – 85 – significantly raised
o Urate – 568 – significantly raised
o RF, CCP ANA – negative
 Diagnosis
o Characteristic presentation of Gout
o Uric acid crystals around thumb – acute or chronic gout
Crystal arthritis
 Gout
o uric acid crystals
 Calcium phosphate disease
o CPPD crystals
 Irritative
 Acute inflammatory reaction around joints
 Acute onset
 Self-limiting episodes of joint inflammation
 Chronic damage
Gout
Epidemiology
 Common
 1-2% adults
 More common in men

, 2
Sunday, 16th January 2022
Week 1
Medicine
o 4:1 m:f
 Most common cause of inflammatory arthritis in men
 Increases with age
Comorbidities are common in gout patients
 Renal impairment
 Coronary heart disease
 Metabolic syndromes
o Obesity
o Dyslipidaemia
o Hypertension
o Diabetes (type 2)
 Important to consider in patients with gout
 May restrict therapeutic options
Risk factors in gout
 Non-modifiable
o Age
o Sex
 Women protected during menstruating years
 Less protection after menopause
o Race
o Genetic factors
 Family clusters
 Not understood why
o Impaired renal function
 Modifiable
o Hyperuricemia
o High-purine diet
o Alcohol consumption
o Obesity
o Medications
Hyperuricemia
 Demonstrated that the higher levels of uric acid lead to gout
Purine rich foods
 Seafood
 Red meat
 Associated with elevated risk of gout
 Dairy products 4% reduction
 Vegetables made little difference
 Men who consume 2 or more sugary soft drinks have an 85% higher change of
getting gout
Alcohol intake
 Varies according to alcohol consumed
 Those that drank beer have a higher risk of gout compared to those who drank
spirits or wine
 Wine made little difference

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