Gout Flashcards
Gout is
Crystal arthropathy
The underlying cause of gout is the chronic blood build up of
Uric acid
Gouty tophi is
Subcutaneous deposits of U acid in joints
Cytokines cause inflammation in hyperurecaemia (gout) due to
Leucocyte immigration to clear u acid
Pseudogout is
Ca pyrophosphate within joints
Vulnerable groups for pseudogout
- elderly
- large joints
- osteoarthritis
Examples of purine rich diet that cause gout
- sea food
- red meat
Examples of pathological states that lead to reduced clearance of uric acid
- dehydration
- CKD
Why do chemotherapy/radiotherapy lead to gout
Dead cells release purine
Drugs that cause gout
- thiazide/loop diuretics
- aspirin
- ACEi
Is gout more common in males or females
Males (FH)
Description of joint in gout attack
Single, acute, hot, swollen and painful
Most affected joints in gout and which particular toe
DIPJs of 1st toe
Other joints affected in gout
- CMTJs
- MTPJs
- wrists
Aspiration findings in gout that exclude bacterial presence
No bacteria on aspiration
Shape of crystals in gout
Needle shaped
Is gout -ve or +ve on polarised light
-very birefringent
Type of urate crystals found in gout aspiration
Monosodium
describe space between joints in XR
Maintained
Describe lesions in bones on XR
Lytic
Describe erosions on XR
Punched out
Describe the borders or erosions on XR
Sclerotic w/ overchanging edges
1st line med in acute flare
NSAIDs
2nd line med in acute flare
Colchicine
3rd line med in acute flare
Steroids
Prophylaxis med
Allopurinol
How does allopurinol reduce uric acid levels
Xanthine oxidase inhibitor
When to initiate allopurinol in relation to acute attackers
After acute attacks has settled
Indications for colchicine use
- NSAIDs inappropriate
- renal impairment
- significant HD
Side effects of colchicine
- GI upset
- diarrhoea
What does colchicine depend on
Dose dependent
