Gout:

Question 1

Patients typically have episodes lasting?

Answer 1

several days when their gout flares and are often symptom-free between episodes

Question 2

acute episodes typically develop maximal intensity with ?

Answer 2

12 hours

Question 3

main features it presents with are?

Answer 3

pain: this is often very significant
swelling
erythema

Question 4

70% of first presentations affect which joint ?

Answer 4

1st metatarsophalangeal (MTP) joint - red, hot, and painful toe

Question 5

Other commonly affected joints in gout ?

Answer 5

ankle
wrist
knee

Question 6

x

Question 7

x

Question 8

x

Question 9

x

Question 10

x

Question 11

diagnosis of Gout?

Answer 11

Synovial fluid analysis - needle shaped negatively birefringent monosodium urate crystals under polarised light

Uric acid

checked once the acute episode has settled down (typically 2 weeks later) as may be high, normal or low during the acute attack

Radiological features of gout

Question 12

what are the radiological features of gout ?

Answer 12

joint effusion -early sign

well-defined ‘punched-out’ erosions with sclerotic margins in a juxta-articular distribution, often with overhanging edges

relative preservation of joint space until late disease

eccentric erosions

no periarticular osteopenia (in contrast to rheumatoid arthritis)

soft tissue tophi may be seen

Question 13

US features of gout ?

Answer 13

double-contour sign a hyperechoic, irregular band over the superficial margin of the joint cartilage,

produced by deposition of monosodium urate crystals on the surface of the hyaline cartilage,

which increases the interface of the cartilage surface, reaching a thickness similar to the subchondral bone.

Question 14

us features of pseudo gout ?

Answer 14

calcium pyrophosphate crystals tend to aggregate in the middle layer of the hyaline cartilage, parallel to the bony cortex, as a hyperechoic, irregular line embedded in the anechoic-appearing hyaline cartilage, with a normal hyaline cartilage surface. Chondrocalcinosis can thus be readily distinguished from gout.

Question 15

x

Question 16

x

Question 17

x

Question 18

x

Question 19

x

Question 20

x

Question 21

x

Question 22

acute management of gout ?

Answer 22

NSAIDs or colchicine

NSAIDS - maximum dose of NSAID should be prescribed until 1-2 days after the symptoms have settled

oral steroids may be considered if NSAIDs and colchicine are contraindicated.

Question 23

Indications for urate-lowering therapy (ULT)

Answer 23

offering urate-lowering therapy to all patients AFTER their first attack of gout

Question 24

urate-lowering therapy (ULT) first line and target ?

Answer 24

allopurinol
initial dose of 100 mg od,
dose titrated every few weeks - aim for a serum uric acid of < 360 µmol/

below 300 µmol/L - patients who have tophi, chronic gouty arthritis or continue to have ongoing frequent flares despite having a uric acid below 360 µmol/L

Question 25

the second-line agent when allopurinol is not tolerated or ineffective is

Answer 25

febuxostat (also a xanthine oxidase inhibitor)

Question 26

in refractory cases for preventive measures not working ?

Answer 26

uricase (urate oxidase)

if uricase dont work pegloticase (polyethylene glycol modified mammalian uricase) can achieve rapid control of hyperuricemia.

Question 27

percipitating drugs that should be stopped ?

Answer 27

(such as thiazides

Question 28

if hypertension what is the best drug to give with gout ?

Answer 28

losartan has a specific uricosuric

Question 29

what supplement are encouraged to be taken in gout ?

Answer 29

vit c