Gout Flashcards
what is the first-line management of an acute gout attack?
- colchicine 500mcg BD-QDS
OR - NSAIDs
what joint is most likely to be affected in gout?
great toe metatarsalphalangeal joint
what is podagra?
gout of the foot
how does gout present?
- excruciating, sudden, burning pain in the affected joint
- swelling, redness, warmth, stiffness in the affected joint
- asymmetric joint distribution
- mild fever
- tachycardia
what investigation provides a definitive diagnosis of gout?
joint aspiration
what does joint aspiration show?
monosodium urate crystals
* needle-shaped crystals
* negative birefringence under polarised light
what medication is used to prevent disease recurrence?
allopurinol
what is allopurinol?
xanthine-oxidase inhibitor which reduces serum urate levels
what are some of the triggers of gout?
- seafood/protein binges
- chemotherapy
- trauma and surgery
- dehydration
what management of acute attacks is used in patients with dialysis or end stage renal failure?
eGFR <10ml/minute/1.73m2
low dose steroids
what is a side-effect of colchicine?
- diarrhoea
- nausea
- vomiting
what are the risk factors for developing gout?
- male
- > 50 years
- family history
- obesity
- hypertension
- chronic kidney disease
- diabetes
- metabolic syndrome
- medications
what medications put you at increased risk for developing gout?
- thiazide diuretics
- ACEi
- aspirin
what investigations should be undertaken in gout?
- arthrocentesis (joint aspiration)
- synovial fluid analysis (gram stain and culture)
- uric acid levels (may be normal) - should be checked 2 weeks post-attack
- x-ray
- ultrasound of affected joint
what are the x-ray findings in gout?
- normal joint space
- soft tissue swelling
- periarticular erosions
