Gout Flashcards
What is it?
Gout is an inflammatory arthritis related to Hyperuricaemia and deposition of monosodium urate crystals
Can cause acute and chronic arthritis, tophi (uric acid crystals soft-tissue masses) around the joints and possible joint destruction; urate nephropathy and uric acid nephrolithiasis.
Modifiable risk factors for gout?
- Increased purine uptake (consumption of meat, seafood)
- Alcohol intake (beer especially)
- High fructose intake
- obesity
- Congestive heart failure
- Coronary artery disease
- Dyslipidemia
- Renal disease
- Organ transplant
- Hypertension
- Smoking
- Diabetes mellitus
- Urate-elevating medications e.g. diuretics
Non-modifiable risk factors for gout?
- Age >40 yrs old
- male sex
- family history of gout
- menopausal status
What else could it be with similar symptoms?
Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD, or Pseudogout)
Hydroxyapatite deposition disease (HADD)
What does the patient present with?
Acute (< 1 Hour) severe onset joint pain with:
- swelling
- effusion
- warmth
- erythema
- tenderness
Cant bear anything touching it
Gouty tophi- subcutaneousdeposits of monosodium urate crystals- DIPS joints most affected
Where does it commonly effect?
Most commonly affects the first metatarsophalangeal joint
Then
foot, ankle, knee, fingers, wrist, elbow
If you have an initial flare what is the probability of a next flare ?
After an initial flare, a second flare occurs in ~60% of patients within 1 year and 78% within 2 years of the initial attack.
What investigations ?
First line:
Arthrocentesis with synovial fluid analysis
Serum uric acid level
X-Ray
If cant do aspiration:
- ultrasound
- Dual energy computed tomography (DECT)
Management of gout: Acute
- NSAIDs
- Oral/IM Steroids
- Colchicine
General prevention: conservative ?
Maintain optimal weight
Regular exercise
Diet modification (purine-rich foods)
Reduce alcohol consumption (beer and liquor)
Smoking cessation
Maintain fluid intake and avoid dehydration
Chronic gout after an acute attack: management? what to aim for on serum urate levels ?
Urate lowering therapy and do not stop treatment (Aim to reduce SUA to < 360micromol/L)
What are the main urate lowering drugs ? MOA?
Main ULTs are allopurinol and febuxostat (both are xanthine oxidase inhibitors and reduce urate
formation)
Benzbromarone and sulfinpyrazone are used less
commonly as more side effects (They act to increase renal excretion of uric acid)
Complications of gout ?
Gout is associated with a high risk of CVD.
joint destruction
Acute uric acid nephropathy
Nephrolithiasis- uric acid calculi
CKD
