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PSEUDOGOUT (PYROPHOSPHATE
)ARTHROPATHY
Aetiology
Two main types of crystal account for the majority of
crystalinduced arthritis:
GOUT
Hyperuricaemia
Gout is an inflammatory
arthritis associated with
hyperuricaemia and intra-
articular sodium urate crystals.
Epidemiology
The prevalence of gout is increasing mainly in
developed countries approximately 0.2% in Europe
and the USA.
More in MEN than women (10:1).
The prevalence in older females is increasing with
increased diuretic use.
Rarely occurs before young adulthood.
Hyperuricaemia is defined as a
serum uric acid level greater than
two standard deviations from the
mean (420 μmol/L in males, 360
μmol/L in females)
Hyperuricaemia
results from
inadequate renal
excretion of uric acid
relative to its
production and is
the major
determinant for
developing gout.
Pathogenesis
Signs and Symptoms
Any joints can show signs and symptoms of gout,
including:
Pain.
Swelling.
Discolouration.
Numbness or tingling (Pins and needles).
Clinical features
Hyperuricaemia can cause four clinical syndromes:
Investigations
The clinical picture is often diagnostic, as is the rapid
response to NSAIDs or colchicine.
Joint fluid microscopy is the most specific and
diagnostic test but is technically difficult.
Serum uric acid is usually raised (> 600 μmol/L).
If it is not, recheck it several weeks after the attack, as
the level falls immediately after an acute attack.
How to differentiate??
In young people it may be associated
with haemochromatosis,
hyperparathyroidism, Wilson’s disease
or alkaptonuria.
Diagnosis
Treatment