Gout Flashcards
what is gout?
a form of inflammatory arthritis.
how does gout present?
- episodes last several days when gout flares
- acute episode develop maximal intensity with 12 hours
- pain
- swelling
- erythema
which joints are typically affected in gout?
- 1st metatarsophalangeal joint (MTP)
- ankle
- wrist
- knee
investigations for gout?
- synovial fluid analysis (needle shape monosodium urate crystals)
- Uric acid (should be checked after 2 weeks of acute episode)
- chronic hyperuriceamia (uric acid > 450umol/l)
Xray features of gout?
- joint effusion (early sign)
- punched out erosions with sclerotic margins
- eccentric erosions
- soft tissue tophi
what is present in RA and not gout?
periarticular osteopenia
Management of Gout (acute management)
- 1st line NSAIDs or colchicine
- gastroproctection (PPI) might be needed with NSAIDs
- do not give NSAIDs if kidney disease suspected
how does colchicine work?
- interferes with mitosis
- inhibits neutrophil motility and activity
- slower onset of action
- should be used with caution in renal impairment
SIDE EFFECT- diarrhoea
what to use if 1st line options are contraindicated?
- steroid- prednisolone 15mg/day
- intra articular steroid injection
what medication should be continued in this case?
if patient is taking allopurinol it should be continued
Allopurinol is a medication used to decrease high levels of uric acid and prevent gout
dose- 100mg od
aim- <300umol/l
When should crate-lowering therapy (UTL) be considered?
- after first acute attack of gout (after 2 weeks)
- more than 2 attacks in 12 months
- tophi
- renal disease
- uric acid renal stones
- prophylaxis if on cytotoxins or diuretics
which medication should be considered with allopurinol?
colchicine till 6 months
second line agent when allopurinol is not tolerated
febuxostat (xanthine oxidase inhibitor)
what treatment should be given for refractory cases
- uricase
- pegloticase
which precipitating drug should be stopped?
- thiazide
