Gout

Question 1

Typical Patient

Answer 1

Male aged 40-50. Generally unhealthy lifestyle.

Question 2

Risk factors

Answer 2

Male
40-50
Smoker
Alcohol (beer)
High red meat intake
Diabetes
Hypertension
Obesity
Dyslipidaemia

Question 3

Presentation

Answer 3

Acute monoarthritis, usually effecting 1st metatarsophalangeal joint
Red, swollen, hot, painful, Reduced ROM, Unable to weight bare
Generally unwell (malaise, fatigue, N/V)
Fever

Question 4

Investigations

Answer 4

Usually based on HPC.

1. Serum urate
2. Joint aspiration and send for cytology
3. Imaging (X-Ray or CT)
4. Routine bloods (Rule out septic arthritis)

Question 5

Cytology features (Gout)

Answer 5

Needle shaped monosodium urate crystals
Negative birefringent under polarised light

Question 6

Cytology features (Pseudogout)

Answer 6

Brick shaped calcium pyrophosphate crystals
Positive birefringent under polarised light

Question 7

Treatment of gout

Answer 7

1. NSAIDs
2. Colchicine
3. Steroids (PO or IA)
4. Allopurinol once initial flare resolved if 2nd event (2-4 weeks later)

Question 8

Addressing risk factors

Answer 8

1. Control BP
2. Control DM
3. Weight loss
4. Smoking/ Alcohol cessation
5. Dietary advice
6. Prevent dehydration

Question 9

Triggers

Answer 9

1. High purine meal (Red meat)
2. Trauma
3. Infection
4. Dehydration
5. Excess alcohol intake (Beer)