GOUT Flashcards
What is it
a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 0.45 mmol/l).
drug causes
diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin
how long do the episodes last
episodes lasting several days when their gout flares and are often symptom-free between episode
how long do acute episodes develop to maximal intensity
12 hours
main features
pain
swelling
erythema
where
1st metatarsophalangeal (MTP) joint. Attacks of gout affecting this area were historically called podagra.
Other commonly affected joints include:
ankle
wrist
knee
what happens if left untreated?
acute episodes of gout can damage the joints resulting in a more chronic joint problem.
ix
- synovial fluid analysis
- uric acid
- xray
what is seen on synovial fluid analysis
needle shaped negatively birefringent monosodium urate crystals under polarised light
when should uric acid be checked
once the acute episode has settled down (typically 2 weeks later) as may be high, normal or low during the acute attack
what radiological features are seen
joint effusion is an early sign
well-defined ‘punched-out’ erosions with sclerotic margins in a juxta-articular distribution, often with overhanging edges
relative preservation of joint space until late disease
eccentric erosions
no periarticular osteopenia (in contrast to rheumatoid arthritis)
soft tissue tophi may be seen
Acute Mx
- NSAIDS
- Colchine
- oral steroids
- intra-articular stereos injections
- if the patient is already taking allopurinol this should be continued
what should be prescribed with NSAID?
ppi
what is the onset of colchine
slow onset
what is the main side effect of colchine
diarrhoea
