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ID:62067298
大小:3.74 MB
页数:64页
时间:2021-04-14
《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》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
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/24hrsOverproducerUricacid<800mg/24hrsUnderexecreterSpoturineuricacidThefamousPodagra-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
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