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Gout and pseudo gout are the 2 most common crystal-induced arthropathies. They are debilitating illnesses in which pain and joint inflammation are caused by the formation of crystals within the joint space.
Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or underexcretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels.
Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis and is characterized by deposition of monosodium urate monohydrate crystals in synovial fluid and other tissues or the formation of uric acid stones in the kidney, leading to neutrophil activation and synovial inflammation. Attacks usually begin as a severe monoarticular inflammatory synovitis in the lower extremities.
Gout is inflammation caused by monosodium urate monohydrate (MSU) crystals.
Pseudo gout is inflammation caused by calcium pyrophosphate (CPP) crystals and is sometimes referred to as calcium pyrophosphate disease (CPPD)
Pseudo gout, which may be clinically indistinguishable from gout, was recognized as a distinct disease entity only in 1962
Presents with acute gout like episode in about 30%
Attack develops over 12 - 36 hours and persists for 1-2 weeks
5% pseudo-rheumatoid appearance
50% chronic disease with progressive joint degeneration (ordinary degenerative osteoarthritis or degenerative spondylosis)
The remainder remain asymptomatic
Knee is usual site (accounts for ~ 50%) but other larger joints may be affected
Inflammation of one or more joints lasting several days and usually less severe than gout.
May present in association with true gout
Seldom affects the great toe
Diagnosis confirmed by positively birefringent crystals in synovial fluid (Gout negative)
Chronic chondrocalcinosis is usually asymptomatic but may lead to poly-articular osteoarthritis
As with gout, pseudo gout has been associated with a variety of metabolic disorders as well as with aging and trauma. Treatment of the acute phase of pseudo gout is identical to that of gout. However, unlike gout treatment, no specific therapeutic regimen exists to treat the underlying cause of pseudo gout, and no known prophylactic therapy for pseudo gout exists
The most commonly affected sites for gout attack are the first metatarsophalangeal joint, the ankle, and the soft tissue of the midfoot. However, gouty arthritis may affect the joints and soft tissues of any extremity. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids
History
History and physical examination alone cannot reliably determine the cause of new-onset acute monoarticular arthritis.
Septic arthritis, gout, and pseudo gout can present in very similar ways.
The spontaneous onset of pain, edema, and inflammation in the metatarsal-phalangeal joint of the great toe (podagra) is highly suggestive of acute crystal-induced arthritis because this is the most common presentation of gout.
Other than the great toe, the most common sites of gouty arthritis are the ankle, wrist, and knee. Consider the diagnosis in any patient with acute monarticular arthritis of any peripheral joint except the glenohumeral joint of the shoulder, in which a crystal-induced arthritis is more likely to be due to pseudo gout.
The most common sites of pseudo gout arthritis are the knee, wrist, and shoulder. Case reports have documented carpal tunnel syndrome as an initial presentation of pseudo gout.
Crystal-induced arthritis is most commonly monarticular; however, polyarticular acute flares are not rare, and many different joints may be involved simultaneously or in rapid succession. Multiple joints in the same limb often are involved, as when inflammation begins in the great toe and then progresses to involve the midfoot and ankle.
Although gout and pseudo gout cannot reliably be distinguished on clinical grounds, a tendency exists for gout symptoms to develop rapidly over a few hours, whereas the onset of symptoms in pseudo gout is usually more insidious and may occur over several days.
When a patient presents with an identical recurrent attack of crystal-induced arthritis, the diagnosis is rarely in question, but the possibility of septic arthritis must always be borne in mind.
Fever, chills, and malaise do not distinguish cellulitis or septic arthritis from crystal-induced arthritis because all 3 illnesses can produce these signs and symptoms.
A careful history may uncover risk factors for cellulitis or septic arthritis, such as possible exposure to gonorrhea, a recent puncture wound over the joint, or systemic signs of disseminated infection.
Physical
Patients with gout or pseudo gout most often present with a single joint that is hot, erythematous, tender, and affected with asymmetrical edema.
If inflammation is severe, desquamation of overlying skin may be present.
Extraarticular deposits of MSU, known as tophi, may be seen along the Achilles tendon or on the ear helix, olecranon bursa, or prepatellar bursa.
Migratory polyarthritis is a rare presentation.
Inflammatory synovial effusion
Carpal tunnel syndrome
Kidney stones
Involved areas are exquisitely painful and erythematous. Fever and a toxic appearance may be seen in older patients.
Although mild attacks are usually short-lived (7 to 10 days), severe untreated attacks may last several weeks. Tophi occur in less than 10% of patients.
The above opinionated views and information serves to educated and informed consumer . The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation.A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions
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