This document discusses gout, osteoarthritis, pseudogout, and osteoporosis. Gout is caused by uric acid crystal deposition in joints, causing inflammation. It predominantly affects middle-aged males and is associated with diet, medications, and other diseases. Osteoarthritis is a degenerative joint disease affecting knees and hips that worsens with age, obesity, and trauma. Osteoporosis is a disease characterized by low bone mineral density and increased fracture risk, often affecting post-menopausal women. Risk factors, diagnosis, and management are described for each condition.

1. Gout & Osteoarthritis
and
Osteoporosis

2. Gout
 ~10% people with hyperuricemia have gout
 Predominantly middle-aged males
 Due to deposition of uric acid crystals in
joints, causing acute inflammation
 Causes-
 Diet-alcohol, sugar, meat, seafood
 Drugs- diuretics, niacin, aspirin
 Other diseases- obesity, DM, HT, CRI, MPD, hemolytic anemia,
lead toxicity

3. Clinical features
 s/s-
 Acute, recurrent inflammatory monoarthritis-
most common in 1st
MTP joint, fever common
 Chronic arthritis- in ~10 years, due to tophi
 Tophi- hard non-tender uric acid crystal deposits
 Uric acid urinary calculi- pain, obstruction
 Dx-
 Mono-sodium urate crystals in synovial fluid or tophi,
needle shaped strongly -ve birefringent
 Hyperuricemia ±
 Rx-
 Acute- NSAIDs, steroids, Colchicine
 Prophylaxis- started 1-2 weeks after an acute attack,
Allopurinol, Probenecid- keep UA levels below 6 mg%

4. Acute gout & tophi

5. Pseudogout
 Calcium pyrophosphate dihydrate- CPPD-
crystal deposition in joint cartilage
 Cause-
 Age, trauma, hyperparathyroidism, hemochromatosis etc.
 Causes intermittent mono-arthritis, commonly
of knee, hip, wrist
 Dx-
 X-ray
 CPPD crystals in synovial fluid-
rhombus shaped, +vely birefringent
 Rx- NSAIDs, steroids-oral/intra-articular

6. Osteoarthritis
 A degenerative joint disease
 Primary or Secondary
 Incidence increases with age
 Obesity & trauma increase risk
 Characterized by joint pain related to use,
worse in evening
 Knee & hip joints most commonly involved-
weight bearing
 Heberden’s-DIP & Bouchard’s-PIP nodes

7. Management
 Dx-
 Clinical
 X-rays to confirm
 Rx-
 Weight loss
 Exercise- to strengthen muscles
 Analgesics- paracetamolNSAIDs
 Arthroscopic intervention
 Joint replacement

8. Osteoporosis
 A disease of the bones
 Common in post-menopausal females
 Characterized by reduced bone mineral
density- 2.5 SD below peak bone mass
 Leads to an increased risk of fragility
fractures in spine, hip, wrist & ribs
 Affects life expectancy & quality of life

9. Pathogenesis
 Imbalance between bone formation &
resorption
 Mechanisms-
 Inadequate
 Excessive bone resorption
 Inadequate new bone formation during remodelling
 Trabecular bone is more subject to
remodelling, hence bones with high
trabecular to cortical bone ratio are more
prone for osteoporotic fractures

10. Risk factors for osteoporotic #
 Non-modifiable-
 Advanced age, female sex
 Family history of osteoporosis or fractures
 Potentially modifiable-
 Chronic heavy alcohol intake, smoking
 Vitamin D deficiency, malnutrition
 Physical inactivity or excess physical activity

11. Risk factors for osteoporotic #
 Diseases-
 Immobilization, of any cause
 Hypogonadism
 Cushing’s,
hyperparathyroidism,
thyrotoxicosis, acromegaly
 Malabsorption
 Rheumatological disorders
 CRI
 Multiple myeloma
 Parkinson’s disease
 COPD
 Drugs-
 Steroids- Prednisolone,
7.5 mg OD for >3
months
 Barbiturates, Phenytoin
 Thyroxine
 Aromatase inhibitors
 GnRH agonists
 Heparin, Warfarin
 PPI
 Al-containing antacids
 Thiozolidenediones

12. Management
 Dx-
 DXA- dual energy X-ray absorptiometry- gold standard
 Quantitative CT/US
 X-ray- for diagnosis of fractures or osteopenia
 Rx-
 Anti-resorptive- bisphosphonates, raloxifene, calcitonin,
estrogen/testosterone replacement
 Bone anabolic- teriparatide, calcium & vitamin D
 Others- strontium ranelate, denosumab
 Exercise, any- aerobic, weight-bearing, resistance

13. Prevention
 Screening- USPSTF
 Females >65 or >60 at increased risk
 Males >80 or >65 with prior fracture
 Prevention-
 Prevent falls
 Smoking cessation, moderation of alcohol intake
 Exercise & good nutrition, specially vit. D & calcium
 Bisphosphonates/Raloxifene/HRT- in post-menopausal females
 Testosterone in hypogonadal men