0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37
432 Cryptosporidiosis Crystal-Induced Arthritis■Contraindications to treatment: relative: none.
follow-up
During Treatment
■General status.Routine
■Infection is self-limiting in immunocompetent patients, no follow
needed after symptoms subside. See HIV section for immunocom-
promised patients.complications and prognosis
■Prognosis is good.Crystal-Induced Arthritis...............................
SHAUN RUDDY, MD
history & physical
History
■Inflammation caused by crystals of monosodium urate (MSU) (gout)
or calcium pyrophosphate dihydrate (pseudogout or CPPD disease)
■Usually middle-aged men; very rare in premenopausal women
■Acute arthritis: abrupt onset of intense pain in a single joint, typ-
ically the first MTP (podagra) in gout; in knee, ankle or wrist for
pseudogout
■Subacute or chronic gout or CPPD disease: polyarthritis involving
fingers, toes, wrists, ankles, elbows, knees, shoulders
■Tophaceous gout: due to deposition of MSU deposits in distal
extremities, ears, erosion of adjacent structures
■Gout in family, obesity, hyperlipidemia, ethanol excess, hyperten-
sion, “syndrome X,” trauma, surgery, ketosis
■Uric acid kidney stones
■Conditions leading to overproduction of uric acid
■Congenital disorders of purine salvage pathway (rare)
➣Proliferative disorders
➣Hematologic–eg, myeloma, lymphoma, polycythemia, hemo-
globinopathies, treatment of other neoplasms
➣Cutaneous – eg, psoriasis
➣Bone: Paget’s disease