Crystal arthropathy Flashcards
What is gout?
Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium.
What causes gout?
Gout is caused by chronic hyperuricaemia (uric acid > 0.45 mmol/l).
What are some drug causes of gout?
Diuretics (thiazides, furosemide), ciclosporin, alcohol, cytotoxic agents, pyrazinamide, and aspirin.
How does aspirin relate to gout?
It was previously thought that only high-dose aspirin could precipitate gout. However, low-dose (e.g. 75mg) also increases the risk of gout attacks.
What should be considered when prescribing aspirin for gout patients?
The risk of gout attacks needs to be balanced against the cardiovascular benefits of aspirin.
What did the study show regarding allopurinol and aspirin?
The study showed that patients coprescribed allopurinol were not at an increased risk of gout attacks.
What is gout?
Gout is a form of inflammatory arthritis characterized by episodes of intense pain, swelling, and erythema.
How long do gout flares typically last?
Patients typically have episodes lasting several days and are often symptom-free between episodes.
What is the time frame for maximal intensity of acute gout episodes?
The acute episodes typically develop maximal intensity within 12 hours.
What are the main features of gout?
The main features of gout include significant pain, swelling, and erythema.
Which joint is most commonly affected in first presentations of gout?
Around 70% of first presentations affect the 1st metatarsophalangeal (MTP) joint.
What is the historical term for gout attacks affecting the 1st MTP joint?
Attacks of gout affecting this area were historically called podagra.
What are other commonly affected joints in gout?
Other commonly affected joints include the ankle, wrist, and knee.
What can happen if gout is untreated?
If untreated, repeated acute episodes of gout can damage the joints, resulting in a more chronic joint problem.
What does NICE recommend for investigating suspected gout?
NICE recommends measuring uric acid levels in suspected gout during the acute setting.
What uric acid level supports a diagnosis of gout?
A uric acid level ≥ 360 umol/L is seen as supporting a diagnosis.
What should be done if uric acid level is < 360 umol/L during a flare?
If uric acid level < 360 umol/L during a flare and gout is strongly suspected, repeat the uric acid level measurement at least 2 weeks after the flare has settled.
What is observed in synovial fluid analysis for gout?
Needle shaped negatively birefringent monosodium urate crystals under polarised light.
What are the radiological features of gout?
Radiological features include joint effusion, well-defined ‘punched-out’ erosions, relative preservation of joint space until late disease, eccentric erosions, and no periarticular osteopenia.
What may be seen in soft tissues of patients with gout?
Soft tissue tophi may be seen.
What is gout?
Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium due to chronic hyperuricaemia (uric acid > 450 µmol/l).
What are the first-line treatments for acute gout management?
NSAIDs or colchicine are first-line treatments.
What is the recommended maximum dose of NSAIDs for gout?
The maximum dose of NSAID should be prescribed until 1-2 days after the symptoms have settled.
What gastroprotection may be indicated during acute gout management?
Gastroprotection, such as a proton pump inhibitor, may also be indicated.