Metabolic Bone Diseases
MTP Swollen In CRF Middle Aged Male
Uric Acid-Middle aged male with swollen MTP is classical presentation of GOUT.
a. Sterotype patient is obese, hypertensive male and fond of alcohol
b. Acute attack is sudden onset of severe joint pain that lasts for a week or two, usually comes out of blue but may be precipitated by minor trauma, illness, unaccustomed exercise or alcohol, steroid withdrawal, hypouricemic therapy, MI, stroke
c. The commonest sites are metatarsophalangeal joint of big toe > ankle & finger joints and olecranon bursae.
d. The skin is red, shiny, swollen, hot and extremely tender suggesting a cellulitis or septic arthritis.
e. Characteristic negatively birefringenturate crystals in the synovial fluid examined by polarizing microscopy is diagnostic.
f. During acute gouty attack strongly birefringent needle and rod shaped mono sodium urate (MSU) crystals with negative elongation are largely intracellular.
g. During acute attack x-rays show only soft tissue swelling. Chronic gout may result in joint space narrowing & secondary OA Tophi appear as characteristic punched out cysts or deep erosions with over hanging bony edges (Martel’s or G’ sign).
h. These well-defined erosions are larger & slightly further from joint margin than typical RA erosions.