Roger’s Painful Toe

Due to
1. Gout
  1. Monoarthritis
    1. Differential Diagnosis
    2. Evaluation and clinical approach
    3. Septic Arthritis
      1. Causative agents
    4. Pseudogout
      1. Chondrocalcinosis
        Deposition of calcium pyrophosophate dihydrate crystals
        Calcium pyrophosophate dihydrate disease "CPPD"
        Weakly positively birefringent (blue) rhomboid-shaped crystals
        Large joints (KNEE or wrist) / Other joints
    5. Periarthritis
      1. Pain in the joint
      2. Calcium crystals deposited
      3. 1-4 weeks
      4. Hypercalcemic conditions
      5. Triggered by trauma
      6. Relieving pain / Self limited
      7. Confirmed by X-ray / US
    6. Articular vs. Non-articular
      1. ROM
        Articular
        Pain on active and passive motion
        Non-articular
        Specific motion
      2. Tenderness
        Articular
        Surface circumference
        Non-articular
        Over bony prominence along tendons
      3. Pain
        Articular
        Generalized, deep or diffuse pain
        Non-articular
        Localized
    7. Inflammatory vs. non-inflammatory
  2. Hyperuricaemia
    1. Deposition of Monosodium Urate Crystals
      1. Due to purine abnormality
        Purine Metabolism
        Purine degradation
      2. Negatively birefringent (yellow) needle-shaped crystals
      3. First metatarsophalangeal joint (BIG TOE) / Other joints
  3. Stages
    1. Asymptomatic hyperuricemia
      1. No symptoms / Hyperuricaemia / Crystals are forming in joint
      2. Before the first attack
    2. Acute gout “Gout attack”
      1. Painful arthritic attack of sudden onset
      2. Damage starts
    3. Interval gout
      1. Period between the attacks
      2. No pain, but a low level of inflammation
    4. Chronic gout
      1. Frequencies increase + Chronic hyperuricaemia
        Complications
        Joint damage and chronic pain
        Large subcutaneous tophi
        Deposition of urate crystals in kidney
        Kidney failure
        Destroyed articular cartilage
        Joint deformity and loss of mobility
        Psychological and emotional problems
  4. Causes and Risk Factors
    1. Age and gender
    2. Genetics
    3. Lifestyle choices
    4. Lead exposure
    5. Medications
      1. Thiazide diuretics
      2. Aspirin
    6. Weight
    7. Recent trauma or surgery
    8. Other health problems
      1. Renal insufficiency
  5. Pathogenesis
  6. Investigations
    1. Blood test
    2. Joint fluid test (Arthrocentesis)
    3. Radiology
      1. X-ray
      2. US
      3. Dual energy CT scan
  7. Management
    1. Acute
    2. Chronic

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Roger’s Painful Toe

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	Creado por Alya Almualla hace alrededor de 5 años