Gout Flashcards
What is gout?
A crystal arthropathy associated with chronically high serum uric acid
Urate crystals deposited into joints causing pain and swelling
What are gouty tophi?
Gouty tophi are subcutaneous deposits of uric acid typically affecting the small joints and connective tissues of the hands, elbows and ears
What is are the differentials for gout?
Septic arthritis (most important to rule out)
Pseudogout
RA
OA
Reactive arthritis etc…
Risk factors for gout
Male Obesity High purine diet (e.g. meat and seafood) Alcohol Diuretics Existing cardiovascular or kidney disease Family history
Typical joints affected by gout
Base of the big toe (metatarsophalangeal joint)
Wrists
Base of thumb (carpometacarpal joints)
Can also affect large joints like the knee and ankle
Investigations and diagnosis for gout
Aspiration of joint fluid
- No bacterial growth
- Crystals are:
- Negatively birefringent
- Needle shaped
- Monosodium urate
Joint X-ray
- Joint space maintained
- Lytic lesions in bone
- Punched out erosions
- Erosions can have sclerotic borders with overhanging edges
Management of gout
Acute flare:
- NSAIDs are first line
- Colchicine second line or if NSAIDs contraindicated
- Steroids third line
- (Allopurinol not used in acute flares, but continue it if already on it)
Prophylaxis;
- Allopurinol is first line, may need to cover with colchicine as allopurinol can take a bit to work
- Second line is Febuxostat
Also lifestyle changes:
- Losing weight
- Drinking plenty of fluid
- Minimising alcohol consumption
- Minimising consumption of purine rich foods e.g. red meat and seafood
Consider stopping precipitating drugs e.g. thiazide diuretics
How does allopurinol work?
Xanthine oxidase inhibitor - reduces the uric acid level
What is a common side effect of colchicine?
Gastrointestinal upset.
Diarrhoea is a very common side effect.
This is dose-dependent meaning lower doses cause less upset than higher doses.
