Gout

Question 1

what is gout?

Answer 1

• This is a crystal arthropathy associated with chronically high uric acid levels.

Question 2

pathophysiology of gout ?

Answer 2

• Urate crystals are deposited in the joint causing it to become hot, swollen, and painful.

Question 3

what are gout tophi and where do they commonly present?

Answer 3

• Gout tophi are subcutaneous deposits of uric acid which typically affect the small joints and connective tissue of the hands, elbows, and ears.
• The DIP joints are the most affected.

Question 4

RF of gout

Answer 4

1) Male
2) Obesity
3) High purine diet (meat/ seafood)
4) Alcohol
5) Diuretics
6) Existing CVD or kidney disease
7) FHx

Question 5

which joints are typically affected in gout?

Answer 5

1) Metatarsophalangeal joint
2) Wrists
3) Carpometacarpal joint
4) Can also affect knee and ankle

Question 6

how is gout diagnosed?

Answer 6

Diagnosis

• Clinical diagnosis or by aspiration of the fluid from the joint.
• Excluding septic arthritis is essential as this is a life-threatening diagnosis.

Question 7

what will aspirate show in gout?

Answer 7

1) No bacterial growth
2) Needle shaped crystals
3) Negative birefringent of polarised light
4) Monosodium urate crystals

Question 8

findings on joint x-ray in gout?

Answer 8

1) Joint space is maintained
2) Lytic lesion in the bone
3) Punched out erosions
4) Erosions can have sclerotic boarders with overhanding edges.

Question 9

how is an acute flare of gout managed?

Answer 9

1) NSAIDs
2) Colchicine
3) Steroids
- Colchicine used in patients that are inappropriate for NSAIDs such as those with renal impairment or heart disease.
- GI upset and diarrhoea are common SE which is dose dependent so a lower dose can help with this.

Question 10

how is gout managed prophylactically?

Answer 10

• Allopurinol is an xanthine oxidate inhibitor which reduces the uric acid levels.
• Lifestyle changes can reduce the risk of developing gout such as losing weight, staying hydrated, and minimising consumption of foods such as alcohol, and purine based foods.

Question 11

what should you ensure not to do in gout management?

Answer 11

• Do not initiate allopurinol prophylaxis until after the acute attack is settled, once treatment of allopurinol has been started then it can be continued during an acute attack.*