4.10 Gout and Pseudogout
Rheumotology review for the USMLE Step 1 Exam.
Gout
- Caused by uric acid crystal deposition due to purine metabolism.
- Triggers inflammation when crystals precipitate in cooler joint fluid.
- Presents with severe, red, and swollen monoarticular joints, often in the big toe.
- Diagnosis through synovial fluid analysis.
- Acute treatment: colchicine, NSAIDs, and glucocorticoids.
- Preventive treatment: allopurinol, febuxostat, probenecid, and lifestyle changes.
Pseudogout
- Resulting from calcium pyrophosphate crystal deposition, often due to ATP breakdown.
- Manifests with painful, swollen joints, typically affecting multiple upper extremity joints, especially the knee.
- Diagnosis through synovial fluid analysis.
- Acute treatment resembles gout management.
- No direct preventive treatment to lower calcium pyrophosphate levels.
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