Gout Flashcards
What is Gout? (2 points)
- Type of Crystal arthropathy
- Associated w Chronically high Uric acid levels in blood
What is the pathophysiology of Gout? (5 steps)
- Increased Uric acid prod / Decreased excretion
- Raised serum Uric acid
- Deposition of Urate crystals in joints
- Inflamm response
- Gout flare
What joints does Gout typically affect? (3 things)
- First MTP (big toe) (70%)
- Wrists
- Base of thumb (carpometacarpal joints)
What are the RF for Gout? (8 things)
- Age
- Male
- Obesity
- High purine diet (aka meat / sea food)
- Alcohol
- Diuretics
- CVS / Kidney disease
- FHx
What age does first Gout attack usually happen?
Between 30-50 yrs
When does a Woman’s risk of Gout increase?
After Menopause
How does the Onset / Offset of Gout differ it from other types of Arthritis? (2 things)
- Develops very rapidly, n reaches Max severity within 24 hours
- Resolves within 1-2 weeks
What are the CF of a joint of Gout? (3 things)
- Intense stabbing pain (touching it will hurt) (stops dem from sleeping)
- Erythema (red + warm)
- Reduced ROM (bc tender + swollen)
What does the Erythematous joint of Gout resemble?
Cellulitis
What is the Dx of Gout based on?
Clinically (CF + Hx)
If Dx can’t be done clinically, what investigation can you do to confirm Dx of Gout?
Synovial fluid aspiration
What will Synovial fluid aspiration show in Gout? (4 things)
- No BAC growth
- Needle shaped crystals
- Negatively birefringent of Polarised light
- Monosodium Urate Crystals
What investigation should you do for CHRONIC Gout? (2 things)
- XR
- US
What will you see in an X-Ray of Chronic Gout? (4 things)
- Joint space MAINTAINED
- Lytic lesions in bone
- “Punched out” erosions
- Sclerotic borders w Overhanging edges on Erosions
What will you see on an US of Chronic Gout?
Tophi (will appear white)
What is the most important DDx to rule out in Gout?
Septic Arthritis
What would make you think Septic Arthritis is likely in sus Gout? (2 things)
- Systemically unwell + Joint CF
- RF: IVDU
How can you rule out Septic Arthritis in sus Gout?
Refer immediately for Joint Aspiration + Culture
What are some other DDx that present similarly to Gout? (3 things)
- Pseudogout
- Cellulitis
- RA
How can you differentiate between Gout n Pseudogout? (4 things)
Pseudogout:
1. Affects larger joint (aka Knee)
2. More likely in Elderly
3. LESS intense pain
4. Chondrocalcinosis on XR
How can you definitely determine it’s Pseudogout n not Gout?
Synovial fluid aspiration
(will show Rhomboid shaped Positively birefringent Calcium Pyrophosphate crystals)
How can you differentiate between RA and Gout? (3 things)
RA will have:
1. GRADUAL onset of pain
2. Rheumatoid nodules present (but easily confused w Gout Tophi)
3. LESS recurrent flares
What markers are the Same / Different in RA + Gout? (2 things)
- RF: Can be present in both
- Anti-CCP: More specific to RA (but low sensitivity)
What investigation can you do to definitively determine it’s not Gout, n more likely RA?
Synovial fluid aspiration
(won’t show Urate crystals if not Gout)
What are the Mx options for an ACUTE flare up of Gout? (First – Third line)
- FIRST LINE: NSAIDs (ibuprofen)
- SECOND LINE: Colchicine
- THIRD LINE: Steroids
(NCS)
When is Colchicine used instead of NSAIDs in Acute Gout flare up? (2 things)
When NSAIDs inapprop:
1. Renal impairment
2. Significant heart disease
What is a very common Side fx of Colchicine?
Diarrhoea
What is used Long Term for Gout Prophylaxis?
Allopurinol
What class of meds if Allopurinol?
Xanthine oxidase inhibitor
What is the basic MOA of Allopurinol?
Reduces Uric acid levels
What is important to know about prescribing Allopurinol?
Don’t prescribe it until AFTER acute attack has settled
What are some lifestyle changes you should advice for Gout Prophylaxis? (4 things)
- Weight Loss
- Hydration
- X Alcohol
- X Purine-based foods (meat / sea food)
Finished
سُبْحَانَ اللَّهِ وَبِحَمْدِهِ
