Crystal Arthritis Flashcards
What are the four types of gout?
Asymptomatic
Hyperureamic
Acute gout
Chronic tophaceous gout
What are some of the risk factors for gout?
Middle aged male
High alcohol intake
Foods high in purines (meats)
Obesity
What is secondary gout?
It can result from other conditions such as renal insufficiency and long term thiazide use. It can be secondary to high cell turnover states such as lymphoma.
What is the nature of gout and what are its associated symptoms?
It develops overnight and causes extreme pain
It is typically associated with fever and malaise
What are common sites of tophi?
Extensor surfaces, ears and achilles tendons
What investigations should be done in suspected gout?
Should aspirate synovial fluid for analysis.
Need to gram stain and culture to rule out septic arthritis.
Need to look for negatively berefringement crystals under polarised light
Renal function should also be measured as uric acid is renally excreted
ESR and CRP may also be raised
What is the management of gout?
For initial attack use NSAIDs e.g. indomethacin
If this is contraindicated then can use corticosteroids or colchicine
Can also use opioid analgesia
Once the initial attack has subsided then can use lifestyle advice and allopurinol
What is pseudogout?
CPPD (Calcium Pyrophosphate Dihydrate Disease)
Second most common crystal arthritis and more common in older women
How does pseudogout present and how is it diagnosed?
Similar symptoms to gout but in knee, wrist or shoulder.
Rare in smaller joints
It is diagnosed through positively birefringement crystals in polarised light
What are the methods of prevention for gout?
Once the gout attack has fully subsided then wait 3 weeks before starting with conservative measures:
-Lower meat diet
-lose weight
-reduce alcohol
Prophylaxis:
-Allopurinol 100mg then titrate up every 4 weeks until pasma urate <0.3mmol/L
-Once titrated up avoid stopping in acute attacjs
