para>Colchicines and NSAIDs contraindicated in pregnancy
Ongoing Care
Follow-up Recommendations
- Gout: as indicated to control hyperuricemia
- Monitor uric acid level within 6 weeks of diagnosis.
- CPPD: Unlike MU crystals, CPPD crystals deposition is irreversible, so reoccurrence is likely if underlying disorder is not treated or inflammatory pathways are not inhibited.
- Calcium oxalate: referral indicated
Patient Monitoring
- NSAID therapy: Monitor for renal and GI side effects.
- Colchicine: Monitor liver and kidney function if on extended course.
- Calcium oxalate disease warrants nephrology consult to monitor kidney function.
Diet
- Gout: Decrease red meat and seafood.
- Calcium oxalate: Decrease ascorbic acid/oxalates.
Prognosis
- Gout: excellent with appropriate medication to control inflammation and uric acid levels
- CPPD: Fair, due to chronic nature of crystals, but if reversible underlying disease is controlled, then chance of recurrence decreases.
- Calcium oxalate: fair to good if underlying hyperoxalemia is controlled
References
1.Singh JA. Racial and gender disparities among patients with gout. Curr Rheumatol Rep. 2013;15(2):307.
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2.Macmullan P, McCarthy G. Treatment and management of pseudogout: insights for the clinician. Ther Adv Musculoskelet Dis. 2012;4(2):121-131.
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3.Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol. 2013;27(2):137-169.
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4.Lorenz EC, Michet CJ, Milliner DS, et al. Update on oxalate crystal disease. Curr Rheumatol Rep. 2013;15(7):340.
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5.Announ N, Guerne PA. Treating difficult crystal pyrophosphate dehydrate deposition disease. Curr Rheumatol Rep. 2008;10(3):228-234.
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6.Schlesinger N, Schumacher R, Catton M, et al. Colchicine for acute gout. Cochrane Database Syst Rev. 2006;(4):CD006190.
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Additional Reading
- Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76(6):801-808.
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- Mies Richie A, Francis ML. Diagnostic approach to polyarticular joint pain. Am Fam Physician. 2003;68(6):1151-1160.
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- Siva C, Velazquez C, Mody A, et al. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003;68(1):83-90.
See Also
Codes
ICD09
- 712.90 Unspecified crystal arthropathy, site unspecified
- 712.30 Chondrocalcinosis, unspecified, site unspecified
- 712.97 Unspecified crystal arthropathy, ankle and foot
- 712.37 Chondrocalcinosis, unspecified, ankle and foot
- 274.9 Gout, unspecified
- 275.49 Other disorders of calcium metabolism
ICD10
- M11.9 Crystal arthropathy, unspecified
- M11.20 Other chondrocalcinosis, unspecified site
- M11.879 Other specified crystal arthropathies, unspecified ankle and foot
- M1A.9XX0 Chronic gout, unspecified, without tophus (tophi)
SNOMED
- 18834007 Crystal arthropathy (disorder)
- 239834007 Pyrophosphate arthritis (disorder)
- 75468006 Crystal arthropathy of ankle AND/OR foot (disorder)
- 35885006 Hyperuricemia (disorder)
- 90560007 Gout (disorder)
Clinical Pearls
- Gout more likely monoarticular, MTP joint
- CPPD monoarticular or polyarticular, knee common
- Apatite and calcium oxalate not common, usually associated with underlying conditions
- CPPD, apatite, oxalate crystal arthropathy correlates with advanced age more than gout.
- Joint aspiration is key to all crystal arthropathy diagnoses.