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gag_pol_env
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Topics: 12
Posts: 34
09/29/08 - 06:58 PM       #1

What is the treatment for pseudogout??


nightflight1945
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Topics: 32
Posts: 920
09/30/08 - 04:04 AM       #2

Acute Phase most;y emphasize on treatment of inflammation i.e. NSAIDS

Chronic phase : treatment of the underlying disease


docnit
Forum Senior

Topics: 8
Posts: 193
09/30/08 - 07:28 AM       #3

i have some doubts on gout...esp the qs given in kaplans LN (old edition) med..pg 73.

4 diff scenarios...could anyone confirm the answers?

1st q: acute 1st episode

so 1st step in manag: synovial fluid analysis
treatment after confiming: NSAIDS.

q2: same page:
2nd episode 6 months later

now first step: again syn fluid analysis ??

treatment after confirming: ??
Nsaids for present symptoms
if its doesnt go then trial of colchicine till patient better or GI symtpoms appear
intraarticular steroids if patient elderly and cant tolerate NSAIDS or oral therapy.

and measure uric acid level if high and evidence of renal problem start on allopurinol? if renal problems nil then probenicid? and advice dietary modification of low purine diet and reduced alcohol consumption.

3rd q same pg:

4 documented previous episodes after dietary modification and reducing alcohol consumption

next step now: ?? is it treat acute symtpoms as above and then start on allopurinol if uric acid high ?

4th q:
asymptomatic since 2 yrs, on allopurinol...episode reccurs:

what to do now???

and and colchicine should given exactly when?

Thanks a lot!

docnit
Forum Senior

Topics: 8
Posts: 193
09/30/08 - 07:29 AM       #4

and colchicine can be used on low dose as maintanence therapy to prevent relapses like allopurinol/probenicid?

lots of qs but they are all there in the notes with no answers.

Liferocks
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Topics: 5
Posts: 229
09/30/08 - 08:25 AM       #5

1st q: acute 1st episode

so 1st step in manag:NSAIDS (we gotta releive the suffering of pt. first)
treatment after confiming: Advice low purine diet, avoiding alcohol and diuretics and nsaids if needed.

q2: same page:
2nd episode 6 months later

now first step: again Nsaids or colchicine
treatment after confirming: Allopurinol or Advice???

3rd q same pg:

4 documented previous episodes after dietary modification and reducing alcohol consumption

next step now: Allopurinol

4th q:
asymptomatic since 2 yrs, on allopurinol...episode reccurs:

what to do now? --- Colchicine maintainance therapy.


Summary --- 1.Give Nsaids first and then look for confirmation of gout by joint tapping, looking for wbc count in sample (< 50,000) , and confirm with polarized light under microscope.
2.Dont give allopurinol in 1st or 2nd episode, advice about avoiding aggravating factors.
3. Prevention of frequent recurrences with pt. on allopurinol may be done with low dose of colchicine as maintainance therapy.

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docnit
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09/30/08 - 08:28 AM       #6

ok great! thanks smiling face

GOGETA
Trying to get in PGY1
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09/30/08 - 08:45 AM       #7

they still use colchicine tx in USA?

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sucralfate
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Topics: 14
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09/30/08 - 09:50 AM       #8

Always do a synovial fluid analysis if you have an acute joint inflammation, no matter the previous diagnosis. Gout, pseudogout and septic arthritis can occur together and the only way to differentiate each other is by tapping.


nightflight1945
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Topics: 32
Posts: 920
09/30/08 - 12:59 PM       #9

sucralfate wrote:
Always do a synovial fluid analysis if you have an acute joint inflammation, no matter the previous diagnosis. Gout, pseudogout and septic arthritis can occur together and the only way to differentiate each other is by tapping.


Exactly


docnit
Forum Senior

Topics: 8
Posts: 193
09/30/08 - 01:10 PM       #10

yes...i thought of the same too..we need to confirm what we r dealig with b4 Tt.

Liferocks
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10/01/08 - 11:29 AM       #11

Agreenodnod
we gotta do joint tapping as first step, then give nsaids.
And afterwards, proceed according to diagnosis.

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