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《最新Crystal-induced arthritis and osteoarthritis：晶體性關節(jié)炎和骨關節(jié)炎-藥學醫(yī)學精品資料.ppt》由會員上傳分享，免費在線閱讀，更多相關內(nèi)容在教育資源-天天文庫。
1、最新Crystal-inducedarthritisandosteoarthritis：晶體性關節(jié)炎和骨關節(jié)炎-藥學醫(yī)學精品資料“TheGout” JamesGillary,1799Gout-anevildemonattackthetoeHyperuricemiaHyperuricemiaisdefinedasaserumuricacid>7mg/dlinmenand>6mg/dlinwomenThemajorityofpeoplewithhyperuricemianeverdevelopanyclinicalproblemsfromi
2、t("asymptomatichyperuricemia").Howtodistinguishbetweenoverproducersandunderexecreters?24-hrurinecollectionforuricacidUricacid>800mg/24hrs?OverproducerUricacid<800mg/24hrs?UnderexecreterSpoturineuricacidThefamousPodagra-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
