gout

Question 1

name of the crytals

Answer 1

monosodium urate

Question 2

rf

Answer 2

age
FH
males

alchol
Purines
red meat
ckd
diabtes
metabolic syndrome
obese
drugs like aspirin, ace +THIAZIDE DIEUERTCI

Question 2

rf

Answer 2

age
FH
males

alchol
Purines
red meat
ckd
diabtes
metabolic syndrome
obese
drugs like aspirin, ace +THIAZIDE DIEUERTCI

Question 3

triggers

Answer 3

purines (alcoho, protein rich food)

stress
illness

chemo - brekas down cells qquicker

trauma, surgery - breaks down cells

Question 4

symptoms of a flare

Answer 4

Excruciating, sudden, burning pain in the affected joint
Swelling, redness, warmth, and stiffness in the affected joint
Asymmetric joint distribution
Mild fever
Tachycardia as a transient sympathetic response to the pain of an acute attack

Question 5

dx of monoarthropathy

Answer 5

brokern/fractured /trauma

septic arthritis
pseudo gout

Question 6

dx of monoarthropathy

Answer 6

brokern/fractured /trauma

septic arthritis
pseudo gout

Question 7

investigations

Answer 7

arthrocentesis with synovial fluid analysis.

needles shap crystals with negative birfingence

The uric acid level should be obtained at least 2 weeks after the attack as it may be low or falsely normal during the attack. Additionally, gout can develop with serum uric acid levels with the normal range.

X rays of affected joints: The radiological features of gout includes normal joint space, soft tissue swelling and periarticular erosions.

Ultrasound of affected joints

Question 8

management of an acute attack

Answer 8

NSAIDS or colchicine usually first line is indomethicin

but if CI cos ulcers then use colchine

colchicine causes diarrhea so if not tolerated well then do intra articular injection of CS

Question 9

which drugs can cause hyperuricemia

Answer 9

thiazides
chemotherapy - increase cell turn over
salicylates

Question 10

what is allopurnol

Answer 10

its a xanthine oxidase inhibitor

NB- its used as a prolyphlactic not a cure!

It is important to remember that urate lowering therapy should be only be started at least one week after an acute episode has resolved as it may worsen the acute episode. In addition starting or increasing urate lowering therapy can itself cause a gout flare. For this reason, the first 3-6 months of urate lowering therapy are often covered with an NSAID or colchicine until the effective dose is reached. If the patient experiences an acute flare while on urate lowering therapy, they should continue the drug.

Question 11

problems with high uric acide

Answer 11

kindey stones!
arthritis