Gout

Question 1

Definition

Answer 1

Gout is a type of inflammatory arthritis caused by monosodium urate crystals forming inside and around joints, causing sudden flares of severe pain, heat, and swelling.

Question 2

Prevalence

Answer 2

The most common inflammatory arthritis - 2.49%

Question 3

Risk Factors - 7

Answer 3

Anything causing hyperuricaemia:

• CKD, HTN, DM, OA
• Excess alcohol consumption
• Obesity
• Diet (sugar, meat and seafood)
• Genetics
• Males
• Menopause
• Age

Question 4

Presentation - 3

Answer 4

• rapid onset severe pain in MTPJ or other joints
• redness and swelling in MTPJ or other joints
• Tophi (hard nodules)

Question 5

Investigations- 3

Answer 5

Take a history on diet, alcohol consumptions, co-morbidities

Take a synovial fluid aspiration and send for analysis - crystals can be seen under a microscope

Serum urate of 360 micromol/L confirms diagnosis

Question 6

Managementof acute gout

Answer 6

1st LINE
- NSAID at max dose e.g. naproxen. For 1-2 days
- Colchicine
- Prednisolone short course

2nd Line
- corticosteroid injection
- ice packs, rest and elevate
- lifestyle

Measure serum urate levels in a follow up.

Question 7

Complications - 5

Answer 7

Chronic arthritis
Joint damage
Reduced QoL
Renal stones
Tophi

Question 8

Differentials - 5

Answer 8

Bursitis
Pseudogout (non-urate crystal induced arthropathy)
OA
RA
Septic arthritis
Trauma

Question 9

Under a microscope what shape are the crystals causing gout

Answer 9

Needle shaped