Crystal Arthropathy investigations and treatment Flashcards
what investigations are used in gout
raised serum uric acid, raised inflammatory markers, polarised microscopy of synovial fluid, renal impairment, X-rays
what treatment is used in acute gout
NSAIDs(first line), Colchicine, steroids(if intolerant of others)
how long does acute gout take to resolve with treatment and without
with = around 3 days without = around 10 days
what different ways can steroids be used in gout
orally short course, intramuscularly or if only one joint affected can be intra-articular as long as no infection
what lifestyle modification is useful in preventing further episodes of gout
reduce alcohol, reduce sugary drinks, lose weight if obese etc.
what are some indications for prophylactic treatment of gout
2 or more attacks gout in a year despite lifestyle changes, presence gout tophi, uric acid calculi, chronic renal impairment, HF unable to stop diuretics, chemotherapy patients
what prophylactic/preventative treatments are available in gout treatment
xanthine oxidase inhibitors, uricosuric drugs, IL-1 inhibitors
give an example of a xanthine oxidase inhibitor used in gout, to reduce urate level
allopurinol(first line)
give an example of an uricosuric drug used in gout
sulfinpyrazone
give an example of an IL-1 inhibitor used in gout
canakinumab
when is prophylactic treatment of gout started
2 weeks after attack
what is the target level of serum uric acid
300-360 micromol/L
how long do patients usually need to take prophylactic drugs
usually life long(eg allopurinol)
when can the NSAID, colchicine or steroid treatment be stopped
when safe serum level is reached(300-360)
what treatment is used in pseudogout
NSAIDs, colchicine, steroids(if intolerant of others), rehydration
