Gout Flashcards
What is gout?
Inflammatory arthritis related to hyperuricaemia
What joints are most commonly affected in gout?
1st metatarsophalangeal joint
Acute gout can affect 1 or more joints
What are the non-modifiable risk factors for gout?
- Over 40 years of age
* Male gender
What ate the modifiable risk factors for gout?
- Purine intake (meats and seafood)
- Alcohol intake (beer)
- Fructose intake
- Obesity
- CHF
- CAD
- Dyslipidemia
- Renal disease
- Organ transplant
- HTN
- Smoking
- DM
- Diuretics (rate elevating medications)
What is the pathogenesis of gout?
Hyperuricaemia results in deposition of monosodium urate (MSU) crystals that accumulate in joints and soft tissues leading to acute/chronic arthritis, soft tissue masses (tophi), rate nephropathy and uric acid nephrolithiasis
What is the general approach to gout treatment?
- Maintain good weight
- Exercise regularly
- Diet modification (avoid purine rich foods)
- Reduce alcohol intake
- Stop smoking
- Keep up fluids and avoid dehydration
What is the specific approach to acute gout treatment?
1st line in acute gout - NSAIDs, oral/IM steroids, colchicine
What is the specific approach to chronic gout treatment?
Urate lowering therapy after an acute attack e.g. allopurinol or febuxostat. The aim is to have the serum uric acid level below 360micromol/L
What do gout crystals look like under a microscope?
Negatively birefringent through polarised light
What is pseudogout?
Gout caused by calcium pyrophosphate crystals - usually occurs in older women with OA
How quickly should pharmacological treatment be started in acute gout?
Within 24 hours to be most effective
Does asymptomatic hyperuricaemia need treating?
No
