4.10 Gout and Pseudogout

Rheumotology review for the USMLE Step 1 Exam.

Gout

• Caused by uric acid crystal deposition due to purine metabolism.
• Triggers inflammation when crystals precipitate in cooler joint fluid.
• Presents with severe, red, and swollen monoarticular joints, often in the big toe.
• Diagnosis through synovial fluid analysis.
• Acute treatment: colchicine, NSAIDs, and glucocorticoids.
• Preventive treatment: allopurinol, febuxostat, probenecid, and lifestyle changes.

Pseudogout

• Resulting from calcium pyrophosphate crystal deposition, often due to ATP breakdown.
• Manifests with painful, swollen joints, typically affecting multiple upper extremity joints, especially the knee.
• Diagnosis through synovial fluid analysis.
• Acute treatment resembles gout management.
• No direct preventive treatment to lower calcium pyrophosphate levels.

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