
Diverticulitis
play_arrow Diverticulitis Dr Swapnil Pawar Diverticulitis Hinchey Classification Stage 0 – Clinically mild diverticulitis with just colonic wall thickening on the CT Stage 1a – Pericolic inflammation or phlegmon, and […]
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Gout
Dr Swapnil Pawar
Gout vs. Pseudogout
Gout | Pseudogout | |
Predominant Sites Affected | Small Joints (i.e. 1st MTP) | Large Joints (i.e. knee) |
Clinical Findings | Marked swelling, erythema and tenderness +/- tophi | Swelling and tenderness often less marked than in gout |
Pathophysiology | Uric acid crystal deposition | Calcium pyrophosphate crystal deposition |
Microscopy Findings | Negatively birefringent, needle-like crystals | Positively birefringent, rhomboid crystals |
Radiological Findings | Lytic bony erosions with overhanging sclerotic margins
Tophi |
Chondrocalcinosis
Subchondral cysts |
Risk Factors for Gout
Non-Modifiable
Modifiable
Management of Gout
Acute Flare
Management of an acute gout flare is based on patient comorbidities and contraindications to potential therapy. Options can include:
Urate Lowering Therapy
Urate lowering therapy can be used to prevent further gout glares. The initiation of urate-lowering therapy should be done after acute flares have resolved, as the therapy itself can precipitate an acute gout flare. Options to lower uric acid levels include:
Non-Pharmacological:
Pharmacological:
N.B. Low dose colchicine can be given prophylactically to prevent a flare when commencing urate-lowering therapy.
References:
eTG Complete (2021). Gout. Therapeutic Guidelines. Retrieved 30th September 2021 from https://tgldcdp.tg.org.au.acs.hcn.com.au/viewTopic topicfile=gout&guidelineName=Rheumatology&topicNavigation=navigateTopic#toc_d1e232
Gaffo, A.L. (2021) Clinical manifestations and diagnosis of gout. UpToDate. Retrieved 30th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-gout
Rosenthal, A.K. (2021) Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. UpToDate. Retrieved 30th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-calcium-pyrophosphate-crystal-deposition-cppd-disease
Dr Swapnil Pawar October 26, 2021
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