Gout: Flashcards
Patients typically have episodes lasting?
several days when their gout flares and are often symptom-free between episodes
acute episodes typically develop maximal intensity with ?
12 hours
main features it presents with are?
pain: this is often very significant
swelling
erythema
70% of first presentations affect which joint ?
1st metatarsophalangeal (MTP) joint - red, hot, and painful toe
Other commonly affected joints in gout ?
ankle
wrist
knee
x
x
x
x
x
diagnosis of Gout?
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
what are the radiological features of gout ?
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
US features of gout ?
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.
us features of pseudo gout ?
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.
x
x
x
x
x
x
x
acute management of gout ?
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.
Indications for urate-lowering therapy (ULT)
offering urate-lowering therapy to all patients AFTER their first attack of gout
urate-lowering therapy (ULT) first line and target ?
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
the second-line agent when allopurinol is not tolerated or ineffective is
febuxostat (also a xanthine oxidase inhibitor)
in refractory cases for preventive measures not working ?
uricase (urate oxidase)
if uricase dont work pegloticase (polyethylene glycol modified mammalian uricase) can achieve rapid control of hyperuricemia.
percipitating drugs that should be stopped ?
(such as thiazides
if hypertension what is the best drug to give with gout ?
losartan has a specific uricosuric
what supplement are encouraged to be taken in gout ?
vit c
