Gout

Question 1

What is the most common inflammatory arthritis in men over 30

Answer 1

Gout

Question 2

What are the stages of gout (4)`

Answer 2

-asymptomatic hyperuricema

-acute gouty arthritis

-intercritical gout

-chronic tophaceous gout

Question 3

What are laboratory tests for gout

Answer 3

Uric acid
–males >7mg/dL
–females>6mg/dL

Synovial fluid analysis provides a more accurate diagnosis

Question 4

What would a joint aspirate of gout show

Answer 4

Needle- shaped monosodium urate crystals are negatively birefringent under polarized light

CPPD is rhomboid shaped and positively birefringent

Question 5

What is a martini sign

Answer 5

histology showing a PMNC engulfing a crystal

Question 6

If gout is suspected what should a specimen be sent in?

Answer 6

One in formaldehyde (to dissolve gouty tophi)

One in alcohol (does not dissolve gouty tophi)

Question 7

How to treat acute and chronic gout

Answer 7

acute:
-Colchicine
-NSAIDs
-Corticosteroids
-ACTH

CHRONIC
-colchicine prophylactically
-allopurinol
-uricosurics- probnecid and suflinpyrazone

Question 8

What is the max daily dose of colchicine

Answer 8

6mg

Question 9

Can allopurinol, probenecid or sulfinpyrazone be used for acute gout

Answer 9

no because they may cause an initial hyperuremia

Question 10

How to determine if the patient is an overproducer or underexcretor

Answer 10

-take a 24 hour urinalysis

Question 11

What is more common- an overproducer or an underexretor

Answer 11

underexcretor make up approximately 90% of gout patients

Question 12

What medications should be given if patient is an overproducer or an underexcretor

Answer 12

(Over-achieving… Under-Paid)

-Over: allopurinol

Under: probenecid