Orthopaedics Notes

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This is an extract of our Orthopaedics document, which we sell as part of our Medicine and Surgery Notes collection written by the top tier of Peninsula Medical School students.

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ORTHOPAEDICS Contents:

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Gout Psoriatic arthritis Psuedogout Rheumatoid arthritis

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GOUT Summary Points

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Gout is caused by the deposition of monosodium urate crystals in a joint

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Patients present with acute, severely painful, swollen joint

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Confirm with synovial fluid aspiration, as gout crystals are negatively birefringent under polarised light

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Manage acute attacks with NSAIDs, and allopurinol for prophylaxis from future attacks Aetiology and Pathophysiology Gout is a condition whereby there is deposition of monosodium urate monohydrate crystals in joints causing inflammation and eventual tissue damage. It is one of the most acutely painful conditions known. They affect the joints of the upper and lower limbs. Types:

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Primary 95% - acute attacks, genetic influence due to overproduction or underexcretion of uric acid Secondary 5% - usually due to chronic diuretic therapy/changes in uric acid metabolism

Further subdivided into:

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Asymptomatic

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Hyperuricaemic

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Acute

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Intercritical/chronic tophaceous Most patients with hyperuricaemia never develop gout and patients with gout do not need to have hyperuricaemia at the time of presentation. Crystals deposited in and around joint and can be found in synovial fluid Most cases are due to the undersecretion of uric acid. <10% are due to its overproduction. However, important to note that you can have normoproduction w/
gout, so associated risk factors play a significant role. Epidemiology and Associated Risk Factors Incidence 12-18/100,000 Asian and Pacific Islanders have a much higher prevalence and a more severe disease. Risk factors:

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Male sex (5:1) - female prevalence increases after menopause Meat and seafood Alcohol Obesity, high triglycerides, hypertension, coronary heart disease Diabetes mellitus Chronic kidney disease Asian ethnicity

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