Gout Flashcards
What is the pathological process of gout? (3)
- Prolonged hyperuricemia leads to the formation of monosodium urate crystals
- These deposit in the synovium
- Joint inflammation is mediated by phagocytosis of the crystals
What is this an image of?
extensive bone erosive destruction due to chronic gout
What is the most common site of gout?
The first metatarsophalangeal joint
Describe this image and suggest a diagnosis
- monosodium urate crystals under polarised light
- the crystals are needle shaped and show negative birefringence
- this is gout
When is colchicine used to treat gout?
When NSAIDs are contraindicated
(eg. renal impairment, peptic ulcers, hypertension)
What can cause hyperuricaemia due to reduced renal excretion? (6)
- drugs
- renal disease
- hypertension
- increased levels or organic acids (lactic acidosis, ketoacidosis)
- hyperthyroidism
- hyperparathyroidism
The serum urate is often raised in a patient with gout, but is may also be normal during an acute gout attack. Why is this?
due to inflammation
What types of food can increase the risk of gout? (4)
- food high in protein
- shellfish
- red meats
- food with a high fructose content
What is trophus?
soft tissue deposits of urate
True or false?
Hyperuricemia is usually due to increased production of uric acid
False
although it is possible, it is usually due to reduced renal excretion of uric acid
What 3 investigations can be carried out for gout?
- polarised light microscopy of synovial fluid
- serum urate
- x-ray
What 5 events can precipitate an acute gout attack?
- trauma
- illness
- surgery
- binge drinking
- starvation
What is Gout?
Gout is the consequence of high levels of hyperuricemia and uric acid crystal formation
Are CRP, ESR and WCC sometimes elevated during acute gout?
yes
What can cause hyperuricaemia due to increased uric acid production? (3)
- increased dietary intake of purines
- increased turnover of purines
- increased purine synthesis - HGPRT (ii) deficiency
True or false?
You should not start allopurinol during an acute gout attack, but you also shouldn’t stop it during an attack either
True
How does an acute gout attack present?
- sudden onset
- excruciating pain worse on movement
- hot, red, swollen joint
- shiny skin
What drugs increase the chances of hyperuricaemia? (4)
- diuretics
- low dose salicylates
- pyrazinamide
- ethanol
What will an X ray of a joint with early stage gout look like?
soft tissue damage
Asides from the 1st MTP joint, what 5 joints may also be affected by gout?
- ankle
- foot
- hand
- wrist
- elbow
- knee
What will polarised light microscopy of the synovial fluid from a joint with gout show?
negatively birefringent
needle shaped
urate crystals
(pink)
What is chronic gout characterised by?
- trophus formation
- joint destruction in digits
- trophaceous helix of ear
What are 8 risk factors for gout?
- Alcohol - especially beer
- Diet
- Obesity
- Diuretic use
- Male
- Hypertension and renal disease
- Cancer
- Psoriasis
What will an X ray of a joint with chronic gout look like? (2)
- well-defined erosions in juxta-articular bone
- with surrounded sclerosis of the bone
What are the two most common xanthine oxidase inhibiters used to treat gout?
- allopurinol
- febuxostat
Who is most commonly affected by gout?
Men
What is the first line of treatment for acute gout attacks?
Strong NSAIDs
eg. dilofenac
What drugs are used to prevent gout attacks?
Xanthine oxidase inhibiters
