Gout

Question 1

what is gout

Answer 1

a form of arthritis

caused by deposition of monosodium urate crystals in and around the joints

most commonly in the metatarsophalangeal joint (MTPJ)

really acutely painful

Question 2

who gets gout

Answer 2

old men

higher prevalence in developed countries

Question 3

what is the cause of gout

Answer 3

uric acid crystals get deposited in the joint

causes an acute inflammatory response

Question 4

what are the risk factors for gout

Answer 4

obese, hypertension, diabetes

old

male

FH

certain medications e.g. thiazide diuretics

renal impairment so do GFR to investigate

Question 5

how does gout present

Answer 5

excruciating, sudden burning pain in the affected joint

swelling, red, stiff, warmth in the affected joint

mild fever

tachycardia as a sympathetic response

usually presents in the metatarsophalangeal joint

Question 6

how do you investigate gout

Answer 6

Arthrocentesis (joint aspiration) to analyse the synovial fluid

GFR as more common in renal impairment

Question 7

how do you manage gout acutely and long term

Answer 7

Acutely:

• high dose NSAIDs- indomethacin
• colchicine as alternative to NSAIDs
• steroids (intra-articular injection)

long term control:
- ALLOPURINOL- decreases blood uric acid levels

Question 8

what do you give people with recurrent acute attacks of gout (2 or more in a year)

Answer 8

allopurinol to lower urate levels in the blood

only when renal function allows

only start them on it when their acute attack has settled