Gout Flashcards
aetiology/ causes of Gout
hyperuricaemia. this may be due to under excretion or overproduction of urate
risk factors for hyperuricaemia
seafood, meat, alcohol (beer esp), diuretics
risk factors for Gout
seafood, meat, alcohol, aspirin, diuretics, male sex, genetics
presenting symptoms of gout (history and exam)
rapid-onset of severe pain,
usually monoarticular (affects metatarsophalangeal joint of big toe the most)
joint stiffness in the morning,
swelling and joint effusion,
tenderness,
tophi,
red and warm (inflammatory)
what is gout
a disorder of uric acid metabolism causing recurrent bouts of acute arthritis caused by deposition of monosodium urate crystals in joints, and also soft tissues and kidneys
what investigations would you do for suspected gout to CONFIRM gout
arthrocentesis with synovial fluid analysis
other investigations for gout
serum uric acid level, ultrasound and X-ray of joint. uric acid stones may be seen on X-RAY and US
treatment of acute gout (1st line)
NSAIDs, corticosteroids, colchicine
what would you see in the synovial fluid aspirate with GOUT
monosodium urate crystals; needleshaped and negative birefringence
how to exclude septic arthritis
cultures and microscopy
what bloods will be done
FBC, U&Es, CRP and ESR
treatment of recurrent gout
allopurinol
allopurinol vs colchicine
colchicine is first line for acute gout, allopurinol is for long term management of gout
prognosis of gout
Gout attacks are painful and debilitating, but self-limiting. In patients who have not been treated with uric acid-lowering drugs, the risk of recurrence after the first attack is 62%, 78%, and 84% during the first, second, and third year, respectively.[112]
In untreated gout:[113]
About 2% of patients develop severe debilitating arthritis (typically 20 years after the first attack)
Tophi occur in about 50% after 10 years, and 72% after 20 years.
