搜索

搜索

近期热门

开启左侧

[分享] Gout 痛风

[复制链接]
聂响斌 发表于 2013-9-22 17:48 | 显示全部楼层 |阅读模式 打印 上一主题 下一主题 来自: 湖南长沙
 

登陆查看更多精彩内容!

您需要 登录 才可以下载或查看,没有账号?立即注册

x
See: Therapeutic Principles & Anti-Gout Meds

- Discussion:
    - gout refers to articular dz of MSU deposits (tophi) in soft tissues.
    - it is caused by deposition of monosodium urate crystals in poorly perfused tissues, as well as bursae, ligaments, articular cartilage, and synovial membranes;
    - on avgerage, a family history of gout can be obtained in less than half patients'
    - male / female ratio ranging from 7:1 to 9:1
            - females with gout tend to be postmenopausal;
    - pathophysiology
    - predisposing conditions:
            - common chronic diseases assoc w/ gout include alcoholism, obesity, hypertension, CAD, and hypertriglyceridemia;
            - one beer a day may increase the uric acid level by 0.4 mg/dL and cause 50% increase in incident gout;
            - increased dietary purine intake;
            - decreased puring biosynthesis (lack of serum enzyme uricase);
            - medications: thiazide diuretics and antimetabolites
            - conditions which increase purine biosynthesis:
                   - myeloroliferative disorders (polycythemia, AGL, CGL)
                   - multiple myeloma;
                   - sickle cell;
                   - prolonged use of diuretics (thiazide diuretics may precipitate gout);
            - references:
                   - Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men.
                   - The Severe Gout of Emperor Charles V

    - diff dx:
            - gout attacks in the painful TKR
            - pseudogout
    - prognosis:
            - arthritis remits completely and then recurs with increasing frequency;
            - in a pt w/ h/o acute gout, there is an 86% occurance of recurrent acute attack 3-5 days postoperatively if no prophylaxis is used;
            - after 1st attack, 2/3 of these pts will develop 2nd attack w/in 1 year;
            - w/in 2 years, three fourths will suffer a second attack;
            - 1/10 of these pts will not have 2nd attack for following 10 years;
            - w/ chronic gout, tophi develop in cartilage, tendons, and bursae in some patients


- Clinical Presentation:
    - age: attacks of gout usually begin in males between ages of 30 and 50;
            - when women are affected they are usually post-menopausal (and are not on supplemental estrogen);
                    - gout in women should prompt a more detailed work up of enzyme deficiency;
    - patients may complain of very mild attacks developing w/o provocation that abate w/o specific treatment;
    - podagara:
            - classic presentation of acute attack of first MTP joint;
    - hand:
            - may be confused with a hand infection;
            - may present with synovial swelling, joint swelling, tenosynovitis;
            - in the hand look for oval periarticular erosions;
            - multiple erosions will be distributed throughout the carpi and phalanges bilaterally;
            - erosions have sclerotic borders and will often have overhanging edges;
            - unlike classic RA, in early gout, hand and wrist joints will have preserved joint spaces and normal mineralization;

                  ench1.jpg ench2.jpg

    - nephrolithiasis is major extraarticular manifestation;
            - in the urinary tract, the pH is less than 5.7, which causes urate to form of uric acid, which has poor solubility can cause precipitation of uric acid crystals;
            - only small % of pts w/ gout get tophi, but many get renal stones;
            - pure uric acid stones are found in 80%, & uric acid is probably nidus for Ca-Phos & oxalate calculi in remainder;
            - in 1/2, sx from renal stones actually precede arthritis.


- Laboratory Studies for Gout


- Radiographs:
    - in the hand look for oval periarticular erosions;
    - multiple erosions will be distributed throughout the carpi and phalanges bilaterally;
    - erosions have sclerotic borders and will often have overhanging edges;
    - unlike classic RA, in early gout, hand and wrist joints will have preserved joint spaces and normal mineralization;
    - example:
          - case of histologically proven gout involving the proximal 5th metatarsal:


gout1.jpg gout2.jpg



引自:www.wheelessonline.com




 
您需要登录后才可以回帖 登录 | 立即注册

本版积分规则


3关注

314粉丝

102帖子

排行榜
  • 2009年Bárány协会分类委员会(CCBS)将前庭疾病症状分四类:眩晕、头晕、前庭视觉症
    70
  • 解剖 解剖二字,从古至今,都有之。我们从古代
    1902
  • 2009年Bárány协会分类委员会(CCBS)将前庭疾病症状分四类:眩晕、头晕、前庭视觉症
    70
  • 2009年Bárány协会分类委员会(CCBS)将前庭疾病症状分四类:眩晕、头晕、前庭视觉症
    70
  • 解剖 解剖二字,从古至今,都有之。我们从古代
    1902
  • 国家卫生健康委疾控局:《儿童青少年脊柱弯曲异常防控技术指南》 为加强儿童青少年脊
    9070
  • 胆囊炎可以突然(急性)发生或随着时间的推移反复(慢性)发生。 急性胆囊炎的症状:
    1870
  • 乳腺增生(以前称为纤维囊性乳房疾病)包括非癌症引起的乳房疼痛、囊肿和肿块。 大多数
    2570
  • 胆结石是指胆囊内有一个或多个结石存在。胆结石可以无症状,最常见的症状是胆绞痛,但
    2660
  • 胆囊炎可以突然(急性)发生或随着时间的推移反复(慢性)发生。 急性胆囊炎的症状:
    1250
  • 什么是细菌性脑膜炎? 脑膜炎是一种覆盖脑部和脊髓的薄层组织感染。这层组织叫做脑膜
    1620
  • 最近一则招聘通知引起很多人关注,该院计划公开招募若干名劳务派遣制人员,康复招聘是
    2140
  • 蚊子病是一种由黄病毒引起的由蚊子传播的疾病。登革热通常表现突然高热、头痛、肌肉痛
    4660
作者专栏
中国康复治疗师网APP下载
发布主题 快速回复 返回列表

提供优质康复职称考试辅导服务

康复学习就上康复治疗师网

康复医学职业教育O2O创新品牌

10年优越口碑历程见证

  • 官网微信

    每天官微五分钟,一年萌新变大神

    扫码关注
  • APP客户端

    48+W康复治疗师邀您加入!

    下载APP客户端
  • 官方客服
KFZLS.COM

学习是回报率最高的投资!

悄悄变强大,惊艳所有人!

Copyright   ©2012-2021  康复治疗师网Powered by©kfzls.com技术支持:康复治疗师网     ( 湘ICP备12010636号 )|网站地图