FN: Gout Flashcards
1
Q
Pathophysiology
A
- Deposition of monosodium urate crystas in an around joints - erosive arthritis
- may be precipitate by surgery, infection, fasting or diuretics
2
Q
Presentation
A
- M>F = 5:1
- Acute monoarthritis with severe joint inflammation
- Also: assymetric oligoarthritis
- urate depositions in pinna and tendons =Tophi
- Renal disease: radiolucent stones and interstitial nephritis
3
Q
Podagra
A
60% occur @ great toe MTP
Also ankle, foot, hand joints, wrist, elbow, knee
4
Q
Differential
A
- septic arthritis
- Pseudogout
- Haemarthrosis
5
Q
Causes
A
- Hereditary
- Drugs: diuretics, NSAIDS, cytotoxics, pyrazinamide
- Reduced excretion: primary gout, renal impairment
- Raised cell turnover: lymphoma, leukaemia, psoriasis, haemolysis, tumour lysis syndrome
- EtOH excess
- Purine rich foods, beef, pork, lamb, seafood
6
Q
Associations
A
HTN
IHD
Metabolic syndrome
7
Q
Investigations
A
- Polarised light microscopy: negatively birefringement needle-shaped crystals
- Raised serum urate (may be normal)
- X-ray changes occur later
8
Q
X-ray changes
A
- punched-out erosions in juxta-articular bone
9
Q
Acute Rx
A
- NSAID: diclofenac or indomethacin (strong NSAID)
- Colchicine
- NSAIDS CI: warfarin, PUD, HF, CRF
- SE: diarrhoea - In renal impairment: NSAIDS and colchicine are CI - use steroids
10
Q
Prevention conservative
A
Lose wt.
Avoid prolonged fast and EtOH excess
11
Q
Prevention medical
A
- Xanthine oxidase inhibitors: Allopurinol
- Uricosuric drugs
- Recombinant urate oxidase
12
Q
Xanthine oxidase inhibitos
Use and SE
A
- Use if recurrent attacks, tophi or renal stones
- Introduce with NSAID or colchicine cover for 3/12
- SE: rash, fever, reduced WCC (with azathioprine)
13
Q
Uricosuric drugs
A
Probenecid, losartan
Rarely used
14
Q
Recombinant urate oxidase
A
Rasburicase
- May be used pre-cytotoxic therapy
15
Q
When to start allopurinol
A
If patient has 2 attacks in a 12 month period
