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4. Monoarticular joint pain > Gout > Flashcards

Gout Flashcards

1
Q

What is the pathological process of gout? (3)

A
  1. Prolonged hyperuricemia leads to the formation of monosodium urate crystals
  2. These deposit in the synovium
  3. Joint inflammation is mediated by phagocytosis of the crystals
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2
Q

What is this an image of?

A

extensive bone erosive destruction due to chronic gout

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3
Q

What is the most common site of gout?

A

The first metatarsophalangeal joint

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4
Q

Describe this image and suggest a diagnosis

A
  1. monosodium urate crystals under polarised light
  2. the crystals are needle shaped and show negative birefringence
  3. this is gout
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5
Q

When is colchicine used to treat gout?

A

When NSAIDs are contraindicated

(eg. renal impairment, peptic ulcers, hypertension)

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6
Q

What can cause hyperuricaemia due to reduced renal excretion? (6)

A
  1. drugs
  2. renal disease
  3. hypertension
  4. increased levels or organic acids (lactic acidosis, ketoacidosis)
  5. hyperthyroidism
  6. hyperparathyroidism
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7
Q

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?

A

due to inflammation

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8
Q

What types of food can increase the risk of gout? (4)

A
  1. food high in protein
  2. shellfish
  3. red meats
  4. food with a high fructose content
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9
Q

What is trophus?

A

soft tissue deposits of urate

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10
Q

True or false?

Hyperuricemia is usually due to increased production of uric acid

A

False

although it is possible, it is usually due to reduced renal excretion of uric acid

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11
Q

What 3 investigations can be carried out for gout?

A
  1. polarised light microscopy of synovial fluid
  2. serum urate
  3. x-ray
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12
Q

What 5 events can precipitate an acute gout attack?

A
  1. trauma
  2. illness
  3. surgery
  4. binge drinking
  5. starvation
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13
Q

What is Gout?

A

Gout is the consequence of high levels of hyperuricemia and uric acid crystal formation

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14
Q

Are CRP, ESR and WCC sometimes elevated during acute gout?

A

yes

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15
Q

What can cause hyperuricaemia due to increased uric acid production? (3)

A
  1. increased dietary intake of purines
  2. increased turnover of purines
  3. increased purine synthesis - HGPRT (ii) deficiency
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16
Q

True or false?

You should not start allopurinol during an acute gout attack, but you also shouldn’t stop it during an attack either

A

True

17
Q

How does an acute gout attack present?

A
  • sudden onset
  • excruciating pain worse on movement
  • hot, red, swollen joint
  • shiny skin
18
Q

What drugs increase the chances of hyperuricaemia? (4)

A
  • diuretics
  • low dose salicylates
  • pyrazinamide
  • ethanol
19
Q

What will an X ray of a joint with early stage gout look like?

A

soft tissue damage

20
Q

Asides from the 1st MTP joint, what 5 joints may also be affected by gout?

A
  1. ankle
  2. foot
  3. hand
  4. wrist
  5. elbow
  6. knee
21
Q

What will polarised light microscopy of the synovial fluid from a joint with gout show?

A

negatively birefringent

needle shaped

urate crystals

(pink)

22
Q

What is chronic gout characterised by?

A
  • trophus formation
  • joint destruction in digits
  • trophaceous helix of ear
23
Q

What are 8 risk factors for gout?

A
  1. Alcohol - especially beer
  2. Diet
  3. Obesity
  4. Diuretic use
  5. Male
  6. Hypertension and renal disease
  7. Cancer
  8. Psoriasis
24
Q

What will an X ray of a joint with chronic gout look like? (2)

A
  • well-defined erosions in juxta-articular bone
  • with surrounded sclerosis of the bone
25
Q

What are the two most common xanthine oxidase inhibiters used to treat gout?

A
  1. allopurinol
  2. febuxostat
26
Q

Who is most commonly affected by gout?

A

Men

27
Q

What is the first line of treatment for acute gout attacks?

A

Strong NSAIDs

eg. dilofenac

28
Q

What drugs are used to prevent gout attacks?

A

Xanthine oxidase inhibiters

4. Monoarticular joint pain (3 decks)

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