ROGER’s Painful Toe

ROGER’s Painful Toe

1. Biochemistry of purine metabolism

2. DDx of Big Toe Pain

   • Trauma
     • Arthritis
       • Hallux Valgus (Bunion)
         • Hallux rigidus
       • Sesamoiditis
     • Gout
       • Primary gout (90%)
         • Overproducation of uric acid
           • Decreased excretion of uric acid
             • Alcohol consumption
             • Renal failure
           • Diet (seafood, red meat)
           • Fructose containing cyrup
           • Chemotherapy, radiotherapy
       • Secondary gout (10%)
         • Increased cell turnover
           • Inborn errors of metabolism
       • Pathogenesis
       • Risk factors
         • Age
           • Genetics
             • Obesity
               • Medications
                 • Thiazides
                 • Low-dose aspirin
       • Signs and symptoms
         • Podagra
           • Tophi
             • Swollen inflamed joint
         • Complications
           • Joint deformity
             • Osteoarthritis
             • Renal stones
               • Sinus may be infected

3. Pseudogout

   • Deposition of Calcium Pyrophosphate crystals
     • Causes
       • Hyperparathyroidism
         • Hemochromatosis
           • Etidronate disodium therapy
             • Angiography

4. Investigations

   • X-ray
     • CBC
       • Joint aspiration
         • Biochemical tests
           • Uric acid levels
             • BUN levels

5. Management

   • Acute gouty arthritis
     • NSAIDs
       • Corticosteroids
         • Colchicine
   • Hyperuricemia
     • Xanthine oxidase inhibitors
       • Uricoseric drugs
         • Probenecid
           • Pegloticase
       • Allopurinol

6. Prognoisis

   • Treatable with good prognosis if treated directly

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