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Acute Polyarticular Gouty Arthritis

Arthritis Gout Acute Polyarticular


Presentation

  • He has been the chair of Education of EULAR, the coordinator of the EULAR online courses and is presently the President-elect of EULAR Nigel Arden is a Professor of Rheumatic Diseases and an International Leader in Epidemiology and predictive modelling[books.google.com]
  • As the attacks recur, they will become more intense and may spread to other joints in the body. [1] [2] [3] A patient may eventually exprience several attacks per year [1] [2] Presentation of acute gout at the PIP joint Presentation of acute gout at the[physio-pedia.com]
  • Gout can present as polyarticular disease, even in a patient’s initial attack.[clevelandclinicmeded.com]
  • Acute polyarthritis has a very wide differential diagnosis, presenting significant diagnostic difficulties.[patient.info]
  • Can also present with periarticular tophi (aggregates of MSU crystals surrounded by a giant cell inflammatory reaction). Occurs in the setting of long-standing gout.[accessmedicine.mhmedical.com]
Fever
  • Infective Endocarditis Suzanne F Bradley 307 Vascular CatheterRelated Infections Carol E Chenoweth Sanjay Saint 317 Septic Arthritis Vikas I Parekh James Riddell IV 323 HIV and AIDS Daniel R Kaul Powel Kazanjian 331 42 Bioterrorism James C Pile 337 Fever[books.google.com]
  • Bacterial or viral infection, Still's disease, subacute bacterial endocarditis, neoplasm Bradycardia Hypothyroidism Cardiovascular system Mitral regurgitation and stenosis Rheumatic fever Aortic regurgitation Ankylosing spondylitis, rheumatic fever,[aafp.org]
  • Polyarthritis and fever. N Engl J Med . 1994;330(11):769–774. ... 2. Shmerling RH. Evaluation of the adult with polyarticular pain. UpTo-Date. (subscription required). Accessed February 25, 2014. 3.[aafp.org]
  • CRP ), fever and the clinical picture. The main use of aspiration is to detect bacteria and neutrophil granulocytes (in septic arthritis) and crystals (crystal arthropathies). Treatment [ edit ] This section is empty.[en.wikipedia.org]
  • The inflammation experienced during gout flare-ups can become severe enough to cause flu-like symptoms, including high fever, muscle aches, and fatigue. 1 See Inflammatory Arthritis Kidney Stones.[arthritis-health.com]
Sepsis
  • Mortality : reported as 10-30% although probably lower than this in practice Morbidity : local joint destruction, sepsis, osteomyelitis, growth impairments Risk Factor Triad : Pre-existing joint disease (RA, gout etc), loss of Skin Integrity (intra-articular[emergencymedicinecases.com]
  • ., cauda equina syndrome); compartment syndrome, with joint pain exceeding what would be expected based on physical examination findings; and sepsis or infection.[aafp.org]
  • This growing effusion eventually leads to elevated joint pressure that tamponades synovial blood flow and causes cartilage anoxia. 19 Septic arthritis can lead to joint destruction in as few as 10 days and can progress to systemic sepsis. 20 Gram-positive[ahcmedia.com]
Pneumonia
  • CAP Bradley A Sharpe Scott A Flanders 271 Nosocomial Pneumonia Scott A Flanders 279 Urinary Tract Infections Carol E Chenoweth Sanjay Saint 285 Skin and Soft Tissue Infections Lakshmi K Halasyamani 291 Acute Bacterial Meningitis Christopher Kim James[books.google.com]
  • CRITICAL CARE 629 Respiratory Therapy Techniques and Mechanical 636 Management of Acute Respiratory Failure 647 Approach to the Patient With Hemoptysis 654 DISORDERS OF 664 Chronic Obstructive Pulmonary Disease 671 Lung Abscess 678 Idiopathic Interstitial Pneumonias[books.google.com]
  • Other pathogens include Streptococcus pneumoniae and Gram-negative bacilli.[jmgims.co.in]
  • Attacks can be precipitated by minor trauma or intercurrent conditions such as surgery, pregnancy, pneumonia, myocardial infarction, and cerebrovascular accidents. 48 Diagnostic Tests.[ahcmedia.com]
Hemoptysis
  • Considerations 601 Approach to Patients With Systemic Infection 612 Epidemiology and Infection Control 621 PULIMONARY AND CRITICAL CARE 629 Respiratory Therapy Techniques and Mechanical 636 Management of Acute Respiratory Failure 647 Approach to the Patient With Hemoptysis[books.google.com]
  • […] interphalangeals Distal interphalangeals Ankle Metatarsophalangeals Medium and large joints Shoulders Elbows Hips/knees Systemic features Fevers, uveitis, nodules, pneumonitis Malar rash, oral ulcers, pleurisy Rash, gangrene, stroke, headache, wrist drop, hemoptysis[aafp.org]
Pleural Effusion
  • Riddell IV 323 HIV and AIDS Daniel R Kaul Powel Kazanjian 331 42 Bioterrorism James C Pile 337 Fever in the Hospitalized Patient Daniel R Kaul 343 Pulmonary 349 Chronic Obstructive Pulmonary Disease 351 Asthma Michael P Lukela William F Bria II 361 Pleural[books.google.com]
Thrombosis
  • Failure Wassim H Fares Franklin A Michota 159 Bradyarrhythmias Arthur C Kendig Mina K Chung 167 Tachyarrhythmias Arthur C Kendig Mina K Chung 173 Cardiac Arrest David V Gugliotti 189 Syncope Anitha Rajamanickam Saira Noor Franklin A Michota 197 Deep Vein Thrombosis[books.google.com]
  • […] study findings Arthrocentesis reveals urate crystals in synovial fluid Serum uric acid level is increased Radiograph may show joint damage in advanced disease Complications Renal Calculi Atherosclerotic disease Cardiovascular lesions Stroke Coronary Thrombosis[rnpedia.com]
Heart Disease
  • Mina K Chung 173 Cardiac Arrest David V Gugliotti 189 Syncope Anitha Rajamanickam Saira Noor Franklin A Michota 197 Deep Vein Thrombosis Amir K Jaffer 207 Pulmonary Embolism Steven B Deitelzweig 217 Acute Aortic Dissection Eric M Siegal 227 Valvular Heart[books.google.com]
  • Risk Factors for Gout and Hyperuricaemia One third of patients with gout have a positive family history; Uric acid levels increase with obesity, a high protein diet, high alcohol consumption, diabetes mellitus, cholesterol, ischaemic heart disease, and[myvmc.com]
Tachycardia
  • Hypersensitivity, chills, tachycardia, malaise, and fever may also be present. [1] [2] [3] The skin may also become red or purplish, shiny, tense, and warm. [2] Occasionally, acute gouty arthritis can also occur at the fingers, wrist, elbow, knee, ankle[physio-pedia.com]
Arthritis
  • His main research interests are osteoarthritis (OA), treatment strategies in rheumatoid arthritis and glucocorticoids.[books.google.com]
  • Saint 285 Skin and Soft Tissue Infections Lakshmi K Halasyamani 291 Acute Bacterial Meningitis Christopher Kim James C Pile 299 Infective Endocarditis Suzanne F Bradley 307 Vascular CatheterRelated Infections Carol E Chenoweth Sanjay Saint 317 Septic Arthritis[books.google.com]
  • Although septic arthritis usually causes monoarticular arthritis, polyarticular septic arthritis occurs, particularly from streptococcal infection.[clevelandclinicmeded.com]
  • What is acute calcific arthritis of hydroxyapatite disease? How can one distinguish Reactive Arthritis from Septic Arthritis clinically? and many many more…..[emergencymedicinecases.com]
  • Acute polyarticular gout continues to masquerade as other commoner rheumatological disorders such as septic arthritis, rheumatoid arthritis, degenerative joint disease, and even hemiparesis.[experts.umn.edu]
Joint Swelling
  • Ask about morning stiffness and joint swelling.[patient.info]
  • C 3 – 6 SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Evidence rating References Joint swelling, erythema, prolonged morning stiffness (more than one hour), and symmetric pain even at rest are suggestive of inflammatory conditions.[aafp.org]
  • The characteristic symptoms and signs of gout are sudden onset of joint pain, joint swelling, heat in the affected area, and joint redness. These symptoms and signs usually affect a single joint.[medicinenet.com]
  • For instance, a 50-year-old woman with symmetric, progressive polyarticular joint swelling and prolonged morning stiffness would seem to have rheumatoid arthritis.[aafp.org]
  • Radiographic findings suggestive of gout include asymmetric joint swelling and subcortical cysts without erosions. ( See Figure 2. ) Laboratory tests are not useful in diagnosing gout; in some cases, the uric acid level is normal.[ahcmedia.com]
Knee Pain
  • Three days into his admission he begins to complain of severe bilateral wrist, elbow, and right knee pain. On exam, he is febrile to 38.22  C (100.8  F).[basicmedicalkey.com]
  • A 52-year-old female with chronic knee, wrist, and hand stiffness and pain presents with increased left knee pain for the past 3 days. The pain and swelling have been gradual in onset.[ahcmedia.com]
  • Knee pain and osteoarthritis in older adults: A review of community burden and current use of primary health care. Ann Rheum Dis 2001;60:91-7. 34. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, et al.[jmgims.co.in]
  • The patient who presents with psoriasis and knee pain in the absence of inflammation may have the dual diagnosis of psoriasis and osteoarthritis.[aafp.org]
Osteoporosis
  • His research interests focus on the epidemiology of musculoskeletal diseases, with a focus on Osteoarthritis and Osteoporosis.[books.google.com]
  • Infection 823 Demyelinating Diseases 832 Chronic Dementing Conditions 835 Central Nervous System Poisoning 841 Disorders of the Peripheral Nervous System 847 Mononeuropathies Caused by Entrapment 854 APPROACH TO THE DIAGNOSIS 860 DISEASES COMMON IN 874 Osteoporosis[books.google.com]
  • The great toe demonstrates extensive juxta-articular erosions with soft tissue swelling and little osteoporosis o "Punched-out" lytic bone lesion sclerosis of margin o "Mouse / rat bite" from erosion of long-standing soft-tissue tophus o "Overhanging[learningradiology.com]
Joint Deformity
  • Conclusion The treatment of gout should be undertaken early in order to avoid the evolution of the disease to the chronic tophaceous form responsible joint deformities and their functional consequences.[panafrican-med-journal.com]
  • Chronic gouty arthritis No longer common Progressive joint destruction Tophi formation Multiple painless hard nodules with possible joint deformities Bone tophi : urate crystal deposition in bones (e.g., elbows, knees, extensor surfaces of forearms) Soft[amboss.com]
Mononeuropathy
  • […] a Sleep 806 Approach to the Patient With Visual 815 Approach to the Patient With Suspected Infection 823 Demyelinating Diseases 832 Chronic Dementing Conditions 835 Central Nervous System Poisoning 841 Disorders of the Peripheral Nervous System 847 Mononeuropathies[books.google.com]
Peripheral Neuropathy
  • neuropathy SLE, amyloidosis Chorea Antiphospholipid-antibody syndrome, SLE, rheumatic fever Mononeuritis multiplex RA, SLE, Lyme disease, vasculitis (e.g., PAN) Seizures SLE Lymphadenopathy Tumor-associated arthritis, SLE The rightsholder did not grant[aafp.org]

Workup

  • Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test.[panafrican-med-journal.com]
Hyponatremia
  • Disease W Bradley Fields Kevin R Flaherty 375 Pulmonary Hypertension Jordan Messler Allan Ramirez 383 Nephrology 389 Acute Renal Failure Gregory M Bump Rachel Fissell William Fissell 391 Chronic Renal Failure and Dialysis UptalD Patel Joseph M Messana 399 Hyponatremia[books.google.com]
Colitis
  • Complications 451 Spontaneous Bacterial Peritonitis Rangadham Nagarakanti 459 Acute Abdominal Emergencies Mark G Graham Kris Kaulback 463 Inflammatory Bowel Disease Cuckoo Choudhary 471 Gastroenteritis Gretchen Diemer 477 Diarrhea and Clostridium difficile Colitis[books.google.com]
  • […] pneumonitis Malar rash, oral ulcers, pleurisy Rash, gangrene, stroke, headache, wrist drop, hemoptysis, gastrointestinal tract bleeding, proteinuria, hematuria Uveitis, pneumonitis Psoriasis, uveitis Uveitis, urethritis, enteritis Crohn disease, ulcerative colitis[aafp.org]
Pleural Effusion
  • Riddell IV 323 HIV and AIDS Daniel R Kaul Powel Kazanjian 331 42 Bioterrorism James C Pile 337 Fever in the Hospitalized Patient Daniel R Kaul 343 Pulmonary 349 Chronic Obstructive Pulmonary Disease 351 Asthma Michael P Lukela William F Bria II 361 Pleural[books.google.com]

Treatment

  • His main research interests are osteoarthritis (OA), treatment strategies in rheumatoid arthritis and glucocorticoids.[books.google.com]
  • Treatment Recommendations Therapy for acute gout attacks aims to reduce pain and promote a full, early resolution.[mdedge.com]
  • Read about diet, medication, treatment, and remedies. ...[doctor-beller.dipmap.com]
  • Gout Treatment There are a number of possible treatments for acute attacks of gout, including: NSAIDs - Non-Steroidal Anti-Inflammatory Drugs Colchicine Steroids Urate-Lowering Therapy (ULT) This booklet will help you understand more about gout, what[arthritisireland.ie]
  • In patients with gout, probenecid is useful for the treatment of chronic hyperuricemia.[quizlet.com]

Prognosis

  • MRI Signal characteristics of gouty tophi are usually: T1: isointense T2 variable 4 the majority of lesions are characteristically heterogeneously hypointense T1 C (Gd): tophus often enhances Treatment and prognosis Acutely, gout can be managed with non-steroidal[radiopaedia.org]
  • Arthritis of Hydroxyapatite Disease : profound periarticular inflammation with ‘fluffy infiltrates’ on X-ray (see image below) APPROACH TO ACUTE POLYARTHRITIS First, rule out septic arthritis and gout as they can both be polyarticular (which carries a worse prognosis[emergencymedicinecases.com]

Etiology

  • Etiology Gout Deposition of urate crystals into joints Hyperuricemia predisposes to gout Associations : Diabetes mellitus Hypertension Hypercholesterolemia, hypertriglyceridemia Anemia Acute gouty arthritis is not always associated with elevated serum[amboss.com]
  • There are five recognized stages of gout: asymptomatic hyperuricemia acute gouty arthritis intercritical gout (between acute attacks) chronic tophaceous gout gouty nephropathy Etiology The primary risk factor is hyperuricemia, although only a small proportion[radiopaedia.org]
  • […] and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Referral to specialist Unclear etiology Refractory SSx (fails to respond within 14days with treatment) Difficulty in achieving target serum uratelevel/recurrent attacks despite onT.allopurinol 900mg OD Uncontrolled acute gout attacks when serumurate[slideshare.net]
  • This accounts for Etiology: The common denominator of gout is hyperuricemia. Uric acid, the product of purine degradation, is synthesized mainly in the liver.[rheumaknowledgy.com]

Epidemiology

  • His research is focused on a number of key elements in OA including (but not limited to) the epidemiology of osteoarthritis, the application of imaging to better understand structure and function with application to both epidemiologic research and clinical[books.google.com]
  • Infections in Compromised Hosts 593 Clinical Considerations 601 Approach to Patients With Systemic Infection 612 Epidemiology and Infection Control 621 PULIMONARY AND CRITICAL CARE 629 Respiratory Therapy Techniques and Mechanical 636 Management of Acute[books.google.com]
  • Epidemiology Sex : (3:1) Age of onset : 30–60 years Prevalence : 8 million people in the US Higher incidence in African Americans References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
Sex distribution
Age distribution

Pathophysiology

  • […] of uric acid Radical dieting practices that involve starvation Secondary gout associated with drugs Secondary gout associated with other diseases: Diabetes Mellitus Hypertension Leukemia Myeloma Obesity Polycythemia Renal disease Sickle Cell Anemia Pathophysiology[rnpedia.com]
  • ., Lesch-Nyhan syndrome, phosphoribosyl pyrophosphate synthetase overactivity, von Gierke disease ) High-protein diet Obesity Combined decreased excretion and overproduction : high alcohol consumption References: [3] [1] [4] [5] [6] [7] [8] Pathophysiology[amboss.com]
  • Septic arthritis can precede rheumatoid arthritis; however, it is unclear whether there is a causal relationship. 26 Pathophysiology. RA is primarily an inflammation of the synovium.[ahcmedia.com]

Prevention

  • There are three stages in the management of gout: (i) treating the acute attack; (ii) lowering excess stores of uric acid to prevent flares of gouty arthritis and to prevent tissue deposition of urate; and (iii) providing prophylaxis to prevent acute[doctor-beller.dipmap.com]
  • Source: iStock Is it possible to prevent gout? Some of the risk factors for gout are genetic, and those are not preventable. However, many of the risk factors for gout, such as obesity and diet, are controllable.[medicinenet.com]
  • Colchicine may be prescribed for acute attack and used in small doses for prevention. Nausea, vomiting, and diarrhea are toxic effects of colchicines and should be reported to the health care provider.[rnpedia.com]
  • prevention of hyperuricemia - Uricosuric drugs or allopurinol may be used alone or in conjunction.[physio-pedia.com]

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