Gout , Pseudogout & Joint Pain - Everything You Need To Know - Dr. Nabil Ebraheim
Вставка
- Опубліковано 30 лип 2024
- Dr. Ebraheim’s educational animated video describes the condition of gout and psuedogout - arthritis and joint pain.
Follow me on twitter:
#!/DrEbraheim_UTMC
Find me on Instagram @OrthoInitiative
Gout, Pseudogout, and Joint Pain
The most common joint affected by gout is the first metatarsophalangeal joint. The most common joint affected by pseudogout is the knee joint. Gout and pseudogout both show a sudden onset of pain, redness, and swelling typically affecting a single joint in 80% of the cases. Gout and pseudogout are similar problems with different causes. Gout is caused by the buildup of uric acid and the deposit of uric acid crystals inside a joint. The best test to diagnose gout is with a joint fluid analysis. Gout crystals are needle shaped and negatively bifringent. When placed under polarized light, they will be yellow. 90% of patients suffering from gout are men between the ages of 40-60 years old. Gout symptoms and signs include joint pain, swelling and arthritis. Patients with gout have periarticular erosions along with the formation of uric acid soft tissue masses in and around the joint which can be seen on x-ray. Soft tissue tophus deposition with periarticular erosions “punch-out” lesions. The tophi occurs due to deposition of uric acid crystals. The tophus aspirate may look like tooth paste. The sudden attack of gout can be brought on by anything that increases the level of uric acid in the blood such as: dehydration, increased consumption of alcohol, eating large amounts of meat or seafood, or trauma/surgery. Other risk factors for gout are obesity, hypertension, and diuretics. Red meats, seafood, liquor, beer, all increase the risk of gout. Vegetables, wine, dairy products, and total proteins do not increase the risk of gout. Aspiration and analysis of the joint fluid is the best method for diagnosis. Elevate uric acid is not diagnostic. 80% of people with elevated uric acid will not get a gouty attack. There are blood tests such as white blood cell count, C-reactive protein, sedimentation rate, and uric acid level that are helpful in supporting the diagnosis if elevated, but if these levels are normal, it cannot definitively rule out gout or pseudogout. Every time you aspirate a joint and you get synovial fluid, you need to analyze it for cell count differential, find out if you have crystals or not and send the fluid for culture and sensitivity if you suspect infection. It might be difficult to differentiate an acute gouty attach from acute septic arthritis. Patients with an acute gouty arthritis may not have an elevated serum uric acid level. A patient with acute gouty arthritis may present with symptoms and a clinical picture that is similar to septic arthritis. Aspirate the joint fluid, and the joint fluid will look like pus, but it could be gout. The incidence of gout and associated septic arthritis of a joint is low (about 1.5%). The incidence of septic arthritis will increase to 11% or more if the cell count is more than 50,000. We aspirate the joint (aspirate will look cloudy, like pus). We look for crystals and if there is crystals, then it is gout, but the presence of uric acid crystals does not exclude septic arthritis. We look at the cell count (will be high, 50,000 or more). The neutrophil count may be 80% or more (we think there is an infection in addition to gout or maybe gout alone). We need to culture the fluid. After we aspirate the fluid and send the fluid for culture, then we give the patient empiric intravenous antibiotics pending the culture result. Remember that gout and septic arthritis can occur together, but the incidence is low. The incidence will increase significantly if the cell count is more than 50,000. Pseudogout or chondrocalcinosis is the deposition of calcium pyrophosphate dihydrate crystals in the hyaline cartilage or fibrocartilage (CPPD). Pseudogout is a metabolic disease where calcium pyrophosphate dehydrate crystals (CPPD) are formed within the joint space. Pseudogout most often affects the knee, occurs more in older patients, and is a calcification of fibrocartilage (chondrocalcinosis). Pseudogout crystals are rhomboid shaped and positively birefringent. Crystals will be blue when placed under polarized light. Associated conditions include hyperparathyroidism, rheumatoid arthritis, and gout. Aspirate to see if it is pseudogout or infection, because you do not want to inject the knee with steroids when there is an infection. You need to look for the rhomboid crystals of pseudogout. X-rays in pseudogout will show thin calcification in the articular cartilage or menisci. Calcifications of the synovium, tendon, and ligaments can also occur. Acute gout can be treated with indomethacin or colchicine if the patient cannot tolerate NSAIDs. Colchicine inhibits the inflammatory mediators and is indicated if the patient cannot tolerate indomethacin. Chronic gout can be treated with allopurinol to prevent buildup of uric acid.
No one is going anywhere near an excruciatingly painful joint of mine with a needle for any reason, period!
Thanks for being so honest and real. Excellent video!
Great teacher , helping the medics through e-learning
Thank you for the clear differention of the three entities
Very informative..keep making such videos
Good, thanks
Thanks a lot. More than my doctor could explain
Devoted Teacher!
Thank you, it was very helpful ! .
Excelant lecture on gout pain 👍
thanks very muuch Sir. it was really helpful
Thank you
what about methotrexate and hydroxychloroquine in chronic pseudogout ? they were also in my study notes.
Sir calcium deposit in my thumb of hand and it can't move now what should I do
I need to get in contact with you dr about an urgent case had calvicle fracture after fixation
Why wine was included into the list as not increase the risk? It is alcogol too, right?
Dr running or jogging every day on hard surface ( road) is harm to knee pls rply
Keep fighting for anyone that deals with this diseaese. Its brutal aint it!! I've never had it in my big toe,although strangely my big toe "pops" many times during my attacks elsewhere..but 1st attack started in elbow almost a year after a surgery, moved to wrist. 11 days Diagnosed as gout through aspiration and blood test. 2nd attack was in a foot/ankle that was previously mangled and was in middle of tendinitis issue. Very painful 17 days. Now currently on 3rd major attack and it's in my knee which has osgood schlatter disease and was in the middle of a case of bursitis. 15 days so far and it's wrecking havoc on my patellar tendon, which is already compromised from Osgood Schlatters. It seems my attacks always show up on already weakened areas and current battles taking place. Is this still gout, or would it be Pseudo?
You are lucky that you have good drs to diagnose you. Me not so much. I empathize though. I know and understand the severe pain. I am drinking water with a baking soda. It is helping for now.
Thank You, Professor. I would like to ask you concerning other topic: which meniscal tears are relevant (if you could answer me if possible in correlation with MRI images). Some of the radiologist use Lotysch classification. What is relevant for you as an orthopedic surgeon in mri report?
Lotysch classification is a very good one
Hi from México. Thanks
Buenísimo
Yo quick question, can gout be counteracted by putting a ton of sugar in pasta sauce?
I gave up on the orthopedic and rheumatologist, and now rely on Allopurinol and low purine diet. My own experience has me avoiding even high purine vegetables and other foods. I most likely have pseudogout in my knee. I was given hydrochlorothiazide about a decade ago, and that wrecked havoc on all of my joints. Hairline fracture after hairline fracture. A warm embrace to all those with this condition. Also, anyone gotten a hyaluronic acid gel shot over corticosteroid shot?
Any luck on the knee? I'm currently dealing with it in a knee that has Osgood-Schlaters as well. It's extremely painful and destroying my patellar tendon. Curious if you'd had any successes you could point me to as I'd like to walk again.
This thing is painful. But worse having non helpful doctors
If you are suffering from joint pain no need to worry . I was also suffering then one of my friend suggested the ayurveda products from planet ayurveda pitta balance, kuteja parwati vati and now all pain are gone.
Hi Dr Nabil Thanks God bless you
May help your contact!
thank you so much soooo much doctor ... i want to ask if you are from egypt ?
Yes
@@nabilebraheim 😍 so proud of you great doctor .(all love and respect from Algeria )
Nothing about hemochromotisis causing elevated uric acid thus gout? Chelating iron out of the blood with turmeric, ect, is a easy gout fix for many people
Sir my uric acid 5.6 right or wrong
Under 6.0 is good
Hi Nabil bhai ye 100 persent. Kam kerta hai
Hello sir blod put out