(see also: Hyperuricemia) Differential Rheumatoid Arthritis: Infection: w/ rapid destruction of gouty joint (by intraarticular infection), crystalline deposits may be released into synovial fluid, leading to confusion; note that indomethacin can quell the clinical symptoms of early septic arthritis (just as it will w/ gout), and therefore, NSAIDs should not be used to differentiate between … Read more
Discussion: humans lack the enzyme uricase which is involved in elimination of excess nucleic acid purines & nitrogenous waste products through production and excretion of allantoic acid; hence in humans, uric acid is end product of purines degradation; gouty arthritis begins w/ deposition of MSU crystals in synovial & periarticular tissue; factors related to microtophus … Read more
(see also: Therapeutic Principles & Anti-Gout Meds Discussion gout refers to articular dz of MSU deposits (tophi) in soft tissues. it is caused by deposition of monosodium urate crystals in poorly perfused tissues, as well as bursae, ligaments, articular cartilage, and synovial membranes; on average, a family history of gout can be obtained in less … Read more
(see also: cartilage topics) Discussion proteoglycan is a macromolecule constructed of a protein core to which many glycosaminoglycan chains are attached – protein with bound side chains (glycosaminoglycans); to this proteoglycan aggregate, hyaluronic acid is non covalently bound; in osteoarthritis, there is a characteristic reduction in a aggregrating proteoglycans; about 10% of wt of proteoglycan … Read more
(see also: osteoarthritis of the knee) Discussion hyaluronic acid is a glycosaminoglycan found in synovial fluid & cartilage; complex sugar (not a protein) ancient molecule, highly conserved- identical function acts as lubricant and shock absorber; acts as barrier permitting metabolites to pass thru it by diffusion but resists penetration by bacteria and other infectious agents; … Read more
Discussion hyaline cartilage is the most common variety of cartilage; it is found in costal cartilages, articular cartilages, epiphyseal plates, & majority of fetal skeleton that is later replaced by bone; chondrocytes, occupy lacunae generously distributed through the matrix; each peripheral lacuna typically houses a single chondrocyte; deeper lacunae may contain two or more chondrocytes; … Read more
Discussion » orthopaedic infection menu general orders and treatment differential diagnosis » (also consider Brucella melitensis, Borrelia burgdorferi and Treponema pallidum) Painful knee–an unusual cause secondary to pseudomonas septic arthritis of the hip. Septic until proven otherwise: approach to and treatment of the septic joint in adult patients. Indicators for detection of septic arthritis in … Read more
Discussion ARA criteria for RA pathogenesis differential diagnosis: spondyloarthropathies & related chronic seroneg arthritides; systemic lupus erythematosus; scleroderma; dermatomyositis; juvenile rheumatoid arthritis Clinical Aspects » Laboratory Aspects » Radiographic Aspects » Treatment of RA Medical Management of RA » Surgical Treatment cervical spine hand wrist elbow and shoulder: frequently there is concomitant shoulder and elbow … Read more
(see also: Spondyloarthropathies) Discussion psoriasis affects 1-2 % of U.S. population & typically presents w/ well-defined erythematous scaly plaques; only a minority of pts with psoriasis develop arthritis; when arthritis develops, it most often is an asymmetrical oligoarthritis, which at times may be quite destructive; some patients may develop spondylitis (usually will have HLA-B27 antigen); … Read more
Discussion acute arthritis caused by CPPD crystal-induced inflammation; almost as common as gout & may perfectly mimic gout during acute flare; pseudogout attacks occurring before age 50 are uncommon; see: pseudogout occurence after joint replacement references: A histological study of calcium pyrophosphate dihydrate crystal-deposition disease. Clinical features of pseudogout attack. A survey of 50 cases. … Read more