Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Crystal-Induced Arthritis Cushing’s Syndrome 435

more often. Other side effects, including diminished platelet func-

tion, headache, psychosis, impaired renal function, & sodium reten-

tion, probably occur w/ the same frequency.

■Colchicine: diarrhea (undesirable in a pt w/ exquisitely painful toe!),

nausea, bone marrow suppression; do not use in renal disease

■Corticosteroids: glucose intolerance is the main problem w/ short-

term tapering dose. Joint infection is rare after intra-articular injec-

tion.

■Beginning treatment of hyperuricemia often precipitates acute

attacks of arthritis

■Allopurinol: rashes are frequent, more common in renal disease,

include possibly fatal toxic epidermal necrolysis; hepatitis; bone

marrow suppression (adjust dose of concomitant azathioprine, 6-

mercaptopurine)

■Probenecid: not effective w/ decreased renal function; uric acid

stones (advise increased water consumption)

follow-up

■Re-evaluate daily for response to treatment during acute attacks

■Monthly, while controlling recurrent acute attacks or adjusting dose

of anti-hyperuricemic agent

complications & prognosis

■Untreated tophaceous deposits may erode & destroy joints

■Renal calculi occur in 5–10% of pts

■Acute attacks are almost always controlled w/ anti-inflammatory

agents

■W/ adequate control of serum uric acid, tophi reabsorb & recurrent

attacks become infrequent

Cushing’s Syndrome..................................

RICHARD I. DORIN, MD

history & physical

History

■Weight gain, central obesity, increased appetite

■Osteoporosis, fracture, loss of height, renal stones

■Hypertension, diabetes mellitus, metabolic syndrome

■Hypokalemia, alkalosis, polyuria, muscle weakness, cramps