003. Gout Flashcards
What is gout?
Deposition of sodium urate crystals in and around joints leading to inflamamtion within the joint
How does gout typically present?
Typically monoarthropathy that comes on acutely.
Mostly occurs within the MTP of the joint
Associated with high urate levels and can present after trauma, infection, surgery
What are the two main risk factors for gout?
Reduced urate excretion- elderly men, post menapousal females, impaired renal function
Excess urate production- dietary, genetic disorders, drugs (warfarin, alcohol, cytotoxcs)
What are the associations with gout?
Cardiovascular disease
Hypertension
Diabetus mellitus
Chronic renal failure
What investigations are undertaken for gout?
Polarized light microscopy
Serum urate (may be normal)
X-ray
How are gout crystals visualized under polarized light?
Negatively bi-fringent urate crystals
What are the two main pharmacological treatments for gout flares?
What other treatments are available?
High dose NSAIDS
Colchicine
Steroids, Bed cages and ice packs
How do you prevent gout?
Lose weight, avoid prolonged fasting and alchohol XS
Avoid aspirin and purine rich meats (sea food, turkey, bacon and liver)
What drug can be used as a preventative for gout?
Allopurinol/febuxostat
What condition mimics gout but typically occurs in larger joints?
What are the risk factors?
Calcium pyrophosphate deposition
Risk factors are more old age, haemochromatosis or hypophosphataemia
How do calcium pyrophosphate crystals appear under light?
Weakly positively birefringent crustals
What drugs are used when CPPD becomes inflammatory arthritis?
Methotrexate and hydroxychloroquinone
