Gout

Question 1

Definition

Answer 1

Type of crystal arthropathy, which is associated with chronically high levels of uric acid in the blood (hyperuricemia)

Urate crystals cause the problems within the joints in the body

Question 2

Gout tophi

Answer 2

Subcutaneous deposits of uric acid under the skin, rather than in the joint

Usually occur around the small joints and connective tissues of the hands, ears and elbows

DIP’s mot affected joint in the hand

Question 3

Risk factors

Answer 3

Male 1:10 women:men

Obesity

Alcohol consumption

Use of diuretics

Family history

Cardiovascular disease/kidney disease

High purine diet

Question 4

Typical joints affected

Answer 4

Base of big toe (metatarsi-phalangeal joint)
wrist
base of the thumb (cargo-metacarpal joint)
knee
ankle

Question 5

Clinical presentation

Answer 5

ACUTE:
– sudden onset
– single joint
– severe pain
– swollen joint that’s hot
– lasts 1-2 weeks

CHRONIC:
– Recurrent attack- may merge into polyarthritic gout
– joint erosion- chronic pain, stiffness and deformity
– tophi formation
– renal lesions

Question 6

Differential diagnosis

Answer 6

Septic arthritis

important to differentiate as it can be dangerous and very destructive to the joint

Any hot, swole joint with severe pain, always treat it as septic arthritis first before its proved not to be infectious

Question 7

Investigations

Answer 7

Aspirating fluid:
– aspirate fluid from the joint with a needle to differentiate.
gout- no bacteria, needle shaped crystals can be seen
septic arthritis- bacteria

X-ray:
gout:
- joint space maintained
- lytic lesions on bone
- punched out erosions
— sclerotic borders of these erosions
— overhangs of erosions

Question 8

Treatment:

Answer 8

Can be used to treat the flare up or prevent from a flare up (prophylaxis)

Acute flare up treatment:
– NSAID’s (ibuprofen and naproxen)
– colchicine (reduces inflammation caused by the uric acid crystals), used where NSAIDs shouldn’t be used due to patient having renal or cardiovascular impairment
– side effects:
gastrointestinal upset (diarrhoea), dose dependent
– steroids can also be used

Prophylaxis:
– Allopurinol (xanthane oxidase inhibitor), reduces the uric acid in the blood.

dont start allopurinol treatment until after the gout attack has settled, once it has been started treatment can be continued into a gout attack

– eduction on lifestyle changes:
—- losing weight
—- staying hydrated
—- decrease in alcohol and purine rich foods (meat and fish)