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🌱 來自: crystal deposition arthritides

comparison of gout and pseudogout

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• Gout (Rheumatology 2018;58:27)

• Acute Clinical:

  • Sudden onset painful mono-articular arthritis (classically podagra [MTP of great toe]) or bursitis; frequently nocturnal
  • May be polyarticular in subsequent flares
  • Can mimic cellulitis (especially in the foot)

• Chronic Clinical:

  • Solid crystal deposition (tophus) in joints (esp. toes, fingers, wrists, knees) & tissue (esp. olecranon bursa, pinna, Achilles)
  • “Pseudo-RA” w/ polyarticular arthritis w/ morning stiffness or “Pseudo-OA”

• Associated Conditions:

  • Metabolic syndrome; CKD; CHF

• Crystal:

  • Monosodium urate (MSU)

• Polarized Microscopy*:

  • Needle-shaped, negatively birefringent

• Radiographic Findings:

  • Early = nonspecific tissue swelling
  • Late = tophus, joint erosions w/ overhanging edges
  • “Double contour sign” on MSK US
  • DECT: UrA vs. Ca deposits

• Other:

  • a/w uric acid stones; urate nephropathy

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• Pseudogout (NEJM 2016;374:2575)
  • from: Clinical manifestations of CPPD 󰒖
• Acute Clinical:
  • Mono- or asymmetric oligoarthritis (esp knees, wrists, and MCP joints); rare axial involvement (eg, crowned dens syndrome)
• Chronic Clinical:
  • “Pseudo-RA” w/ polyarticular arthritis w/ morning stiffness or “Pseudo-OA”
• Associated Conditions:
  • 3 H’s: Hyper-PTH, Hypo-Mg, Hemochromatosis
• Crystal:
  • Calcium pyrophosphate dihydrate
• Polarized Microscopy*:
  • Rhomboid-shaped, weakly positively birefringent
• Radiographic Findings:
  • Chondrocalcinosis: linear densities within articular cartilage; often found in menisci, fibrocartilage of wrist, hands, symphysis pubis
• Other:
  • ✓ Ca, Mg, Fe, ferritin, TIBC, UrA, PTH in young or severe cases Note: Polarized microscopy is a laboratory technique used to analyze crystals in synovial fluid and helps in the diagnosis of gout and pseudogout.