Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR6 Rheumatology > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

Inflammatory crystal arthropathy caused by precipitation + deposition of uric acid crystals in synovial fluid + tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the broad cause of gout?

A

Hyperuricaemia
Decreased uric acid excretion (90%)
or
Increased production (10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List 3 causes of decreased uric acid excretion

A

Drugs
CKD
Lead nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List 4 drugs that decrease uric acid excretion

A

Aspirin
Thiazide diuretics
Loop diuretics
Pyrazinamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List 3 causes of increased uric acid production

A

High cell turnover
Enzyme defects
Diet rich in protein (esp. purine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List 4 causes of high cell turnover that can increase uric acid production

A

Tumor lysis syndrome
Myeloproliferative/ lymphoproliferative disorders
Psoriasis
Chemo/ Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name a syndrome with enzyme defects causing increased uric acid production

A

Lesch-Nyhan syndrome
X-linked recessive (only seen in boys)
Hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 5 features of Lesch-Nyhan syndrome

A

Gout
Renal failure
Neurological deficits
Self-mutilating behaviour
Learning difficulties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List 4 types of food rich in purines

A

Meat (Liver, Kidneys)
Seafood
Oily fish (Mackerel, sardines)
Yeast products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can cause combined decreased excretion and overproduction of uric acid predisposing to gout?

A

High alcohol consumption esp. beer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does weight impact levels of uric acid?

A

Higher BMI correlates with higher uric acid levels, regardless of dietary habits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe onset of episodes of gout

A

Acute
Typically max. intensity within 12h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 3 S/S of gout

A

Pain +++
Swelling
Erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common joint in first presentation of gout?

A

1st metatarsophalangeal (MTP)
~70%
= Podagra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are peripheral small joints in the lower extremities especially affected in gout?

A

Tissue temperature within them is physiologically lower, which promotes uric acid deposition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 3 other commonly affected joints in gout

A

Ankle
Wrist
Knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does chronic gouty arthritis lead to?

A

Tophi formation
Painless hard nodules with possible joint deformities
May appear yellow/ white because of overlying attenuated skin

18
Q

Where may bone tophi be seen?

A

Elbows
Knees
Extensor surfaces of forearms

19
Q

Where may soft tissue tophi be seen?

A

Pinna of external ear
Achilles tendon
Olecranon bursa

20
Q

What is the gold standard investigation for suspected gout?

A

Arthrocentesis + synovial fluid analysis

21
Q

What is seen on synovial fluid analysis in gout?

A

Needle shaped negatively birefringent monosodium urate crystals under polarised light

22
Q

When should uric acid be measured in gout? What result supports diagnosis?

A

Acutely: Uric acid >,360 umol/L

If <360, repeat once acute episode has settled (~2w later)

23
Q

Why must serum uric acid levels be interpreted with caution?

A

Not always raised in acute gouty arthritis

24
Q

List 4 radiological features of gout

A

Joint effusion (early)
Well-defined punched out erosions with sclerotic margins in a juxta-articular distribution
Eccentric erosions
Soft tissue tophi

25
Q

What are the punched-out lytic bone lesions in gout also known as?

A

Rat-bite erosions

26
Q

Describe first line management of acute gout

A

NSAID at max dose e.g. Naproxen continued until 1-2 days after attack resolved + PPI
or
Colchicine
or
Prednisolone 30-35mg OD for 5 days
+
Continue allopurinol if taking already

27
Q

What are 2 unfavourable features of colchicine use in acute gout?

A

Slower onset of action (than NSAIDs)
SE: Diarrhoea

28
Q

How should colchicine be used in those with renal impairment?

A

Use with caution
Reduce dose if eGFR is 10-50 ml/min
Avoid if eGFR < 10 ml/min

29
Q

What is an alternate treatment of acute gout if colchicine and NSAIDs are contraindicated?

A

Intra-articular/ IM steroid injection

30
Q

In which patients should urate lowering therapy be offered?

A

All patients after their first attack of gout

31
Q

Give 5 indications where urate lowering therapy is particularly recommended

A

> ,2 attacks in 12 months
Tophi
Renal disease
Uric acid renal stones
Prophylaxis if on cytotoxics/ diuretics

32
Q

When should urate lowering therapy be started?

A

Once inflammation has settled as ULT is better discussed when patient is not in pain

33
Q

Why should anti-inflammatories be given during acute gout and for at least 1w before ULT?

A

XOIs during acute flare may exacerbate Sx by mobilising urate crystals

34
Q

What is the first line agent in urate lowering therapy? What is the MOA?

A

Allopurinol 100mg OD with dose titrated every few weeks to aim for a serum uric acid of < 360 µmol/l
Xanthine Oxidase inhibitor

35
Q

In which patients should the starting dose of allopurinol be reduced?

A

Reduced eGFR

36
Q

What additional drug should be considered alongside initiation of allopurinol?

A

Colchicine cover
(NSAIDs if colchicine not tolerated)
May need to be continued for 6 months

37
Q

What is the second line agent in urate lowering therapy? What is the MOA? When is this indicated?

A

Febuxostat
Xanthine Oxidase inhibitor
When allopurinol is not tolerated/ is ineffective

38
Q

Name a drug that can be used in refractory cases for urate lowering therapy

A

Pegloticase
Uricase (Urate oxidase) enzyme that catalyses degradation of urate

39
Q

List 3 lifestyle modifications for management of gout

A

Reduce alcohol + avoid during acute attack
Lose weight if obese
Avoid food high in purines

40
Q

Which drug may be suitable for patients with gout and co-existing hypertension?

A

Losartan
Has specific uricosuric action

41
Q

How does vitamin C intake affect serum uric acid levels?

A

Increased Vitamin C intake decreases uric acid levels

42
Q
A

YR6 Rheumatology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions