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Cơ - Xương - Kh p
Sơ đ 10.4 Gout
What is gout?
Gout is an inflammatory crystal monoarthropathy
caused by the deposition of urate crystals.
These monosodium urate crystals often
precipitate in the metatarsophalangeal joint (MTPJ).
Gout involving the big toe is known as a podagra.
Causes
There are many causes of gout but essentially
anything that increases urate levels may be the
underlying cause. Some examples include,
Horrific
DELAY:
•
Hyperuricaemia, Hereditary.
•
Diuretics (thiazides).
•
Ethanol.
•
Leukaemia.
•
renAl impairment.
•
associated with Lesch–NYhan syndrome.
Signs and symptoms
•
Calor, dolor, rubor and tumour
(heat, pain, redness and swelling)
of the affected joint, which is usually
the MTPJ in 50% of patients.
•
Tophi (urate deposits) may be
present on tendon surfaces, e.g. the
elbow, or visible on the ear.
•
Patients may have symptoms
of renal calculi.
Investigations
•
Bloods: serum urate levels, FBC, WCC, U&Es,
creatinine, ESR, CRP.
•
GFR: assess kidney function.
•
Synovial fluid analysis: positive if birefringent
monosodium urate crystals seen.
Đ c đi m
Gout gi
Gout
Kh p t n thương
Kh p g n, l n
Kh p ĐBNC 1 c đi n
Lo i tinh th
Tinh th Calci
pyrophosphat
Tinh th natri urat
Hình d ng tinh th
Hình bình hành
Hình kim
Hi n vi quang h c Th lư ng chi t
âm tính
Th lư ng chi t
dương tính m nh
Phân bi t Gout gi v i Gout
Bi n ch ng
•
H y kh p.
•
S i th n.
•
H t tophi.
Đi u tr
•
B o t n: giáo d c b nh nhân, thay đ i
l i s ng: gi m rư u bia, ch đ ăn ít
purin. Ki m tra thu c b nh nhân đang
dùng và ng ng thu c có th gây b nh
như thu c l i ti u thiazide, n u có.
•
N i khoa:
Gi m đau.
C p: colchicine và steroids.
M n: allopurinol.
Dùng feboxostat
n u b nh nhân không dung n p allopurinol.
MAP 10.4 Gout
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