Non-Infectious Arthritis PDF

‫كلية الطب – ‪dicine‬‬ C o ll e Gout g e Definition: o f Gout is marked by transient attacks of acute arthritis initiated by M urate crystals deposited within and around joints e d ic Gout is characterized by excessive uric acid (Hyperuricemia: i n plasma urate level above...

‫كلية الطب – ‪dicine‬‬ C o ll e Gout g e Definition: o f Gout is marked by transient attacks of acute arthritis initiated by M urate crystals deposited within and around joints e d ic Gout is characterized by excessive uric acid (Hyperuricemia: i n plasma urate level above 6.8 mg/dL) in tissues and body fluids e – ‫ك‬ Gout may be primary or secondary to some other underlying ‫ل‬ disease ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  Causes of Gout Primary Gout (90%): Enzyme Defect of Uric Acid Metabolism such as hypoxanthine guanine phosphoribosyl transferase (HGPRT) dicine – ‫كلية الطب‬ Secondary Gout (10%): 1- Chronic Renal Disease 2- Congenital 3- Increased nucleotide turnover (e.g. Leukemia) C o (PURINE) ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫كلية الطب – ‪dicine‬‬ C o ll e Gout g e o Morphology f The morphologic changes in gout are M e Acute arthritis d ic Chronic tophaceous arthritis i Gouty nephropathy n e – ‫ك‬ 1- Gouty nephropathy: ‫ل‬ ‫ية‬ - Accumulation of urate crystals or tophi in the renal medullary ‫ا‬ interstitium or tubules ‫ل‬ - Uric acid nephrolithiasis and pyelonephritis ‫ط‬ ‫ب‬  Gout 2- Acute arthritis It is characterized by a dense inflammatory infiltrate in the synovium and synovial fluid. The synovium is edematous and congested dicine – ‫كلية الطب‬ Accumulation of Urate crystals. They are long, slender, and needle-shaped C o ll Gout e g e 3- Chronic tophaceous arthritis (sever form) o f - The Urate crystals cover the articular surface and form visible M e chalky deposits in the synovium d ic - The synovium becomes hyperplastic, fibrotic, and thickened i n e -The synovium forms a pannus that destroys the articular – ‫ك‬ cartilage ‫ل‬ ‫ية‬ -Tophi in the articular cartilage, ligaments, tendons, and ‫ا‬ ‫ل‬ bursae are pathognomonic of gout. They are formed by large ‫ط‬ ‫ب‬ aggregations of urate crystals surrounded by an intense foreign body giant cell reaction dicine – ‫كلية الطب‬ Gouty tophus—an aggregate of dissolved urate crystals is surrounded by reactive fibroblasts, mononuclear inflammatory cells, and giant cells. C o ll e Gout g e o Clinical Course f M Gout is associated with male sex, obesity, metabolic syndrome, e excess alcohol intake, renal failure, age greater than 30 years d ic Four clinical stages are recognized: i n Asymptomatic hyperuricemia e Acute arthritis: joint pain, localized hyperemia, and warmth. – ‫ك‬ Most first attacks are monoarticular; 50% occur in the first ‫ل‬ metatarsophalangeal joint ‫ ية‬ Asymptomatic free interval ‫ا‬ ‫ ل‬ Chronic tophaceous gout: loss of the joint space. ‫ط‬ ‫ب‬  Calcium Pyrophosphate Crystal Deposition Disease CPPD (Pseudogout) Calcium pyrophosphate crystal deposition disease (CPPD), also known as pseudogout. it occurs in individuals more than 50 years old CPPD dicine – ‫الطب‬ ‫كلية‬ Loading… is divided into sporadic (idiopathic), hereditary, and secondary types. Previous joint damage, hyperparathyroidism, hemochromatosis, and diabetes, predispose to the secondary form C o ll e Calcium Pyrophosphate Crystal Deposition Disease g CPPD (Pseudogout) e o f The crystals first develop in the articular cartilage, M menisci, and as the deposits enlarge they may rupture and e d seed the joint ic i n Inflammation is usually milder than in gout e – ‫ك‬ CPPD is frequently asymptomatic ‫ل‬ ‫ية‬ ‫ا‬ The joint involvement may be monoarticular or ‫ل‬ ‫ط‬ polyarticular ‫ب‬