Arthritis Flashcards
Causes of Gout
Alcohol excess Surgical operation Starvation Drugs eg frusemidem thiazide diuretics Chronic kidney disease Myeloproliferative disorders Lymphoproliferative disorders eg leukaemia Sugary soft drinks Cytotoxic agents - tumour lysis Hypothyroidism Low-dose aspirin Others
What is it
Urate crystal deposit
Joints = arthritis
Soft tissue = tophi adn tenosynovitis
Urinary tract = urate stones
Symptoms of Gout
Excruciating pain in joint that is worsen in early hours of morning. Commonly big toe, ankle, knees. Usually mono joint involved. Relieved by colchicine, NSAIDs, and coricosteroids
Signs of examination of gout
Joint to inspect Skin over joint red, shiny, swollen adn hot Feet - Metatarsophalageal joint of great toe. Ankle Knee upper limb - affected late Tophi in ears, elbows (olecranon bursa), big toes, fingers, achilles tendon (after many years) Palpate exquisitely tender to touch Gouty tophi = chronic recurrent gout Occur over synovia and olecranon bursa, the extensor surface of the forearm and helix of ear and infra patellar and achilles tendons Signs of causes of secondary gout Myeloproliferative disease lymphoma leukaemia renal disease Hypothyroidism signs of complication hypertension diabetes mellitus ischaemic heart disease patellar burisits and cellulitis
Diagnosis/Ix for Gout
Diagnosis - synovial fluid aspirate - uric aicd
- Serum uric acid
Xray - punched out erosions at joint margins
Tx of acute Gout
Good advice and education Self limiting 3-10 days Lifestyle modification – weight loss, decreased alcohol, stop diuretics, diet modification to decrease purine rich foods (less seafood/red meat/yeasts) Food to avoid Tinned fish Organ meats alcohol - major one Rizzy, sugary soft drinks Analgesia - NSAIDs, colchicine, glucocorticoids Need to monitioring kidney function
Prevention of further attacks of Gout
Hypouricaemic drugs
Allopurinol is the usual drug of choice because of its once-daily convenience and low incidence of side-effects. It inhibits xanthine oxidase and reduces conversion of hypoxanthine and xanthine to uric acid.
indications
Recurrent attacks of acute gout
Tophi
Evidence of bone or joint damage
Associated renal disease
Gout with greatly elevated serum uric acid
Adverse affects
rash 2%
severe allergic reaction
precaution
beware of kidney insufficiency and elderly pt - use lower doses
Drug interactions - azathioprine and 6 mercaptopurine - potentially lethal
Amoxycillin - prone to rashes.
use with caution as Uric acid levels need to be reduce to normal first before commencing. can make things worse.
