最新Crystal-induced arthritis and osteoarthritis：晶体性关节炎和骨关节炎-药学医学精品资料.ppt

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1、最新Crystal-inducedarthritisandosteoarthritis：晶体性关节炎和骨关节炎-药学医学精品资料“TheGout”JamesGillary,1799Gout-anevildemonattackthetoeHyperuricemiaHyperuricemiaisdefinedasaserumuricacid>7mg/dlinmenand>6mg/dlinwomenThemajorityofpeoplewithhyperuricemianeverdevelopanyclinicalproblemsfromi

2、t("asymptomatichyperuricemia").Howtodistinguishbetweenoverproducersandunderexecreters?24-hrurinecollectionforuricacidUricacid>800mg/24hrsOverproducerUricacid<800mg/24hrsUnderexecreterSpoturineuricacidThefamousPodagra-Suddenonsetofseverepainandswellingatnight-Usuallysin

3、glejoint(85%)orfewerthan4joints-Polyarticulargoutisalaterfeature.-Feverandleukocystosis-Spontaneousresolutionover1-2weeks-Theredappleisreplacedbypurpleplumwithexfoliatingskin.GoutmimicscellulitisChronicDrainingTophiGout-epidemiologyTheprevalenceofgoutintheadultsis1.4%,an

4、dinmenover75is7%(UKGeneralPracticeData).Goutisrareinmalesunder30andinwomenbeforemenopauseThepeakageofonsetinmenis40-50andinwomenisafter60Thereisanassociationbetweenhyperuricemiaandmetabolicsyndrome(insulinresistance,hypertension,obesity,dyslipidemia)CrystalAnalysisbyPola

5、rizedLightMicroscopyMono-sodiumuratecrystalsA.PerpendiculartoPolarizerAxisB.ExtinctionC.ParalleltoPolarizerAxisPolarizingAxisUricacidcrystalsparalleltothepolarizingaxisareyellow,thoseperpendicularareblueAxisMono-sodiumurate:IntracellularIntracellularcrystalsindicateacute

6、flareCrystalAnalysisbyPolarizedLightMicroscopyPresenceofCrystalsShapeofcrystalsNeedlevsRhomboidvsOtherBirefringenceSignofbirefringenceNegativebirefringence(yellow):MSUPositivebirefringence(blue):CPPDApatitenotvisiblebythismethodTophiTophiGout:X-rayRatbiteerosionswithover

7、hangingedgesTophusGout:X-rayGoutyerosionsandolecranontophusUricAcidNephrolithiasisTreatmentofgoutAcuteattackColchicineNSAIDsSteroids(injectionorsystemic)UricacidloweringagentsAllopurinol:XanthineoxidaseinhibitorProbenecid:Uricosuric;inhibitsuratetransporter-1(URAT-1)Febu

8、xostat:Non-purinexanthineoxidaseinhibitorUricaseIndicationsforuricacidloweringagents>2attackswithin1-2y