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MsK > Crystal arthritis > Flashcards

Crystal arthritis Flashcards

1
Q

Define Gout

A

Gout is a syndrome characterised by: hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthriti

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2
Q

Features of crystal arthritis

A

Crystal Arthritis is the commonest cause of acute joint swelling
Gout most common in men
Pseudogout in women

Easy to diagnose and treat
Miserable for patients

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3
Q

Gout features

A

Caused by the deposition of monosodium urate crystals within joint
The immunological reaction initiated to try and remove them, leads to acute pain and swelling
Only ‘Curable’ form of inflammatory arthritis

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4
Q

Epidemiology of gout

A

UK General Practice Research Database – prevalence 1.4% (1999)
7.3% of men aged >75yrs
Overall male : female ratio 5:1

Hyperuricaemia much more common – affects 15% population
Gout prevalence increases with age

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5
Q

Pathogenesis of Gout

A

Under excretion urate + overproduction urate >
Hyperuricaemia >
Crystal formation & shedding >
Synovial cells > Inflammatory response

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6
Q

What causes under excretion urate in gout

A

Genetics
Drugs
CKD
Diuretics
Lead toxicity

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7
Q

What causes overproduction of urate in gout

A

Diet
Alcohol
Metabolic proliferation
Obesity
Psoriasis
Purine rich diet

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8
Q

Causes of Gout

A

Alcohol - mostly beer
Red meat, shellfish, offal
Soft drifts
Psoriasis
Haematological malignancy

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9
Q

What affects renal clearance of uric acid

A

Renal impairment (any cause)
Drugs
Low dose aspirin reduces renal clearance by 10%
Diuretics – worse with higher dose
Cyclosporin, TB drugs, theophyllines

Genetics – affects renal clearance of uric acid
Fructose – shares renal uric acid transporter

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10
Q

Essential risk factors for Gout

A

Renal impairment
Beer
Diuretics
Aspirin
Family History
Fructose
Elderly
Men
Impaired renal function

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11
Q

Clinical features of Gout

A

Acute episodes
Onset often at night
Resolve spontaneously (quicker with treatment)
Usually recur in a predictable pattern of joint involvement

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12
Q

Typical joints that gout affects

A

1st MTPJ 90% metatarsophalangeal joint
Midfoot, ankle, knee, wrist, elbow hand
Periarticular involvement
Olecranon bursitis
Systemic features can occur

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13
Q

Differntial diagnosis for Gout

A

Septic Arthritis
Trauma
Calcium Pyrophosphate Arthritis
Rheumatoid Arthritis
(Osteoarthritis!)

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14
Q

Investigations for Gout

A

FBC (expect raised WCC)
U+E
LFT if concern re alcohol
Serum Uric Acid (often normal during acute attack)!!
CRP
Xray if recurrent episodes or concern re sepsis
Joint aspiration
Joint X ray

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15
Q

4 clinical phases of gout

A

1️⃣asymptomatic hyperuricemia,
2️⃣acute/recurrent gout,
3️⃣intercritical gout,
4️⃣chronic tophaceous gout

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16
Q

Acute treatment of Gout

A

Explain the disease
Advice about lifestyle - alcohol diet weight loss fluid intake
NSAID (short course) unless:
Renal failure
Peptic Ulcer Disease
Some pts with asthma

Colchicine NSAID
500ug 2-3 times daily

Corticosteroids
Intra-articular
Oral - low dose (5-10mg short course)
Ice packs

17
Q

Indication of chronic gout

A
  1. Recurrent attacks
    1. Evidence of tophi or chronic gouty arthritis
    2. Associated renal disease
    3. Normal serum Uric acid cannot be achieved by life-style
      modifications
18
Q

Medications for chronic gout

A
  1. Allopurinol – Xanthine Oxidase Inhibitor
    1. Febuxostat – more potent Xanthine Oxidase Inhibitor
    2. Benzbromarone / Probencid – if allergic / intollerant
18
Q

Complications of Gout

A

Disability and misery
Tophi
Renal disease:
Calculi 10 -15%
Chronic urate nephropathy
Acute urate nephropathy (cytotoxics

19
Q

Pathway of gout

A

Asymptomatic hyperuricaemia
Acute gout
Inter critical gout
Chronic tophaceous gout

20
Q

Acute clinical features of gout

A
  • swelling
  • erythema
  • shiny overlying skin
21
Q

1st line investigation for gout

A

Joint aspiration and polarised light microscopy

MsK (14 decks)

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