Roger’s Painful Toe

Roger’s Painful Toe

1. Due to

   • Gout
     • Monoarthritis
       • Differential Diagnosis
       • Evaluation and clinical approach
       • Septic Arthritis
         • Causative agents
       • Pseudogout
         • 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
       • Periarthritis
         • Pain in the joint
         • Calcium crystals deposited
         • 1-4 weeks
         • Hypercalcemic conditions
         • Triggered by trauma
         • Relieving pain / Self limited
         • Confirmed by X-ray / US
       • Articular vs. Non-articular
         • ROM
           • Articular
             • Pain on active and passive motion
           • Non-articular
             • Specific motion
         • Tenderness
           • Articular
             • Surface circumference
           • Non-articular
             • Over bony prominence along tendons
         • Pain
           • Articular
             • Generalized, deep or diffuse pain
           • Non-articular
             • Localized
       • Inflammatory vs. non-inflammatory
     • Hyperuricaemia
       • Deposition of Monosodium Urate Crystals
         • Due to purine abnormality
           • Purine Metabolism
           • Purine degradation
         • Negatively birefringent (yellow) needle-shaped crystals
         • First metatarsophalangeal joint (BIG TOE) / Other joints
     • Stages
       • Asymptomatic hyperuricemia
         • No symptoms / Hyperuricaemia / Crystals are forming in joint
         • Before the first attack
       • Acute gout “Gout attack”
         • Painful arthritic attack of sudden onset
         • Damage starts
       • Interval gout
         • Period between the attacks
         • No pain, but a low level of inflammation
       • Chronic gout
         • 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
     • Causes and Risk Factors
       • Age and gender
       • Genetics
       • Lifestyle choices
       • Lead exposure
       • Medications
         • Thiazide diuretics
         • Aspirin
       • Weight
       • Recent trauma or surgery
       • Other health problems
         • Renal insufficiency
     • Pathogenesis
     • Investigations
       • Blood test
       • Joint fluid test (Arthrocentesis)
       • Radiology
         • X-ray
         • US
         • Dual energy CT scan
     • Management
       • Acute
       • Chronic

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