Gout/pseudogout
Basics
Description
Description
- Uric acid deposition into tissues, affecting mainly middle-aged men and postmenopausal women:
- Most common crystalline diseases
- 4 phases:
- Asymptomatic hyperuricemia (serum urate >7 mg/dL)
- Acute gout
- Intercritical gout: Quiet intervening periods
- Tophaceous gout (up to 45% of cases)
- Risk factors:
- Age >40
- Male/female ratio 2:1–6:1 <65 yr old; 1:1 ≥65 yr old
- Hypertension
- Use of loop or thiazide diuretics
- High intake of alcohol, meat, seafood, and fructose-sweetened beverages
- Obesity
- Urologic deposition of uric acid calculi may cause renal dysfunction
- Associated with avascular necrosis and deforming arthritis
- Most frequent in previously damaged joints, tissues:
- Synovium
- Subchondral bone
- Bursae (olecranon, infrapatellar, prepatellar)
- Achilles tendon
- Extensor surface of the forearms, toes, fingers, ear
- Rarely CNS or cardiac (valves)
- Pseudogout: A disorder caused by calcium pyrophosphate crystal deposition:
- Most common cause of acute monoarthritis >60 yr of age
- Risk factors:
- Hypercalcemia (e.g., hyperparathyroidism, familial)
- Hemochromatosis; hemosiderosis
- Hypothyroidism and hyperthyroidism
- Hypophosphatemia, hypomagnesemia
- Amyloidosis
- Gout
Etiology
Etiology
- Deposition of monosodium urate crystals in tissues from supersaturated extracellular fluid owing to:
- Underexcretion (most commonly) or excessive production of uric acid
- Any rapid change in uric acid levels:
- Initiation or cessation of diuretics
- Alcohol, salicylates, niacin
- Cyclosporine
- Lead acetate poisoning
- Uricosurics or allopurinol
- Pseudogout occurs secondary to excess synovial accumulation of calcium pyrophosphate crystals
- Precipitants for both gout and pseudogout include minor trauma and acute illnesses:
- Surgery, ischemic heart disease
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Citation
Schaider, Jeffrey J., et al., editors. "Gout/pseudogout." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307732/all/Gout_pseudogout.
Gout/pseudogout. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307732/all/Gout_pseudogout. Accessed December 1, 2024.
Gout/pseudogout. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307732/all/Gout_pseudogout
Gout/pseudogout [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307732/all/Gout_pseudogout.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Emergency Consult
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